The Treatment of Large (&gt;70°) Thoracic Idiopathic Scoliosis Curves With Posterior Instrumentation and Arthrodesis: When is Anterior Release Indicated?

Burton, Douglas C.; Sama, Andrew A.; Asher, Marc A.; Burke, Stephen W.; Boachie-Adjei, Oheneba; Huang, Rongrong; Green, D. W.; Rawlins, Bernard A.

doi:10.1097/01.brs.0000176196.94565.d6

Cited by 70 publications

(45 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The curve patterns according to the Lenke's classification were 9 (36%) type 1, 9 (36%) type 2, 3 (12%) type 3, and 4 (16%) type 4. The PSF-S group showed a preoperative Cobb of 88°(80-136), bent down to 66°(54-110), with a flexibility of 25.62% (12,29), being corrected on average to 58.43 in the Risser's cast preoperative test, final correction down to 40° ; an overall correction of 52.4% (22.79-75), and an average loss of -1.9°(-5.3 to 0) ( Table 1). Fig.…”

Section: Resultsmentioning

confidence: 99%

“…The PSF-H group (n = 27 patients) consisted of 23 female and 4 male patients, with a mean age at surgery of 14.9 years (11)(12)(13)(14)(15)(16)(17)(18)(19)(20), and a mean Risser's sign of 2.34 (0-5). The curve patterns according to the Lenke's classification were 11 (40%) type 1, 9 (33.3%) type 2, 3 (11%) type 3, and 4 (15%) type 4.…”

Section: Resultsmentioning

confidence: 99%

“…Previous studies used posterior-only instrumentation with multiple hooks [18] or hybrid construct [3,12]. De Giorgi et al [18] used CD instrumentation in 19 cases of idiopathic scoliosis between 80°and 145°, and achieved a correction of 53.9%.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, some authors [3,12,14,18,27] have used posterior-only fusion for the treatment of severe thoracic adolescent idiopathic scoliosis (AIS). The correction rate of scoliosis was 53.9% using a hook-only construct [18], 54% with hybrid instrumentation [3], and 67-68% with pedicle screws only [14,27].…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Posterior fusion only for thoracic adolescent idiopathic scoliosis of more than 80°: pedicle screws versus hybrid instrumentation

et al. 2008

View full text Add to dashboard Cite

The treatment of thoracic adolescent idiopathic scoliosis (AIS) of more than 80°traditionally consisted of a combined procedure, an anterior release performed through an open thoracotomy followed by a posterior fusion. Recently, some studies have reassessed the role of posterior fusion only as treatment for severe thoracic AIS; the correction rate of the thoracic curves was comparable to most series of combined anterior and posterior surgery, with shorter surgery time and without the negative effect on pulmonary function of anterior transthoracic exposure. Compared with other studies published so far on the use of posterior fusion alone for severe thoracic AIS, the present study examines a larger group of patients (52 cases) reviewed at a longer follow-up (average 6.7 years, range 4.5-8.5 years). The aim of the study was to evaluate the clinical and radiographic outcome of surgical treatment for severe thoracic ([80°) AIS treated with posterior spinal fusion alone, and compare comprehensively the results of posterior fusion with a hybrid construct (proximal hooks and distal pedicle screws) versus a pedicle screw instrumentation. All patients (n = 52) with main thoracic AIS curves greater than 80°(Lenke type 1, 2, 3, and 4), surgically treated between 1996 and 2000 at one institution, by posterior spinal fusion either with hybrid instrumentation (PSF-H group; n = 27 patients), or with pedicle screw-only construct (PSF-S group; n = 25 patients) were reviewed. There were no differences between the two groups in terms of age, Risser's sign, Cobb preoperative main thoracic (MT) curve magnitude (PSF-H: 92°vs. PSF-S: 88°), or flexibility on bending films (PSF-H: 27% vs. PSF-S: 25%). Statistical analysis was performed using the t test (paired and unpaired), Wilcoxon test for nonparametric paired analysis, and the Mann-Whitney test for non-parametric unpaired analysis. At the last follow-up, the PSF-S group, when compared to the PSF-H group had a final MT correction rate of 52.4 versus 44.52% (P = 0.001), with a loss of -1.9°versus -11.3°( P = 0.0005), a TL/L correction of 50 versus 43% (ns), a greater correction of the lowest instrumented vertebra translation (-1.00 vs. -0.54 cm; P = 0.04), and tilt (-19°vs. -10°; P = 0.005) on the coronal plane. There were no statistically significant differences in sagittal and global coronal alignment between the two groups (C7-S1 offset: PSF-H = 0.5 cm vs. PSF-S = 0 cm). In the hybrid series (27 patients) surgery-related complications necessitated three revision surgeries, whereas in the screw group (25 patients) one revision surgery was performed. No neurological complications or deep wound infection occurred in this series. In conclusion, posterior spinal fusion for severe thoracic AIS with pedicle screws only, when compared to hybrid construct, allowed a greater coronal correction of both main thoracic and secondary lumbar curves, less loss of the postoperative correction achieved, and fewer revision surgeries. Posterior-only fusion with pedicle screws enabled a good and...

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Posterior fusion only for thoracic adolescent idiopathic scoliosis of more than 80°: pedicle screws versus hybrid instrumentation

et al. 2008

View full text Add to dashboard Cite

show abstract

“…90°in this series), where the need of anterior release was even less obvious than this current series. Recent papers on the need of anterior release in curves between 70°and 100°have shown that the anterior release was unnecessary with the modern segmental instrumentation [3][4][5]. In 2000, we published a meta-analysis of anterior release done with thoracoscopic instrumentation and to our surprise the average Cobb angle of the curves being released was only 65°with a maximum of 80° [6].…”

mentioning

confidence: 89%

Comment regarding “Is anterior release effective to increase flexibility in idiopathic thoracic scoliosis? Assessment by traction films” (A. Hempfing et al.)

Arlet

2006

Eur Spine J

View full text Add to dashboard Cite

show abstract

Idiopathic Scoliosis

Haefeli

Min

Spinal Disorders

View full text Add to dashboard Cite

The Treatment of Large (>70°) Thoracic Idiopathic Scoliosis Curves With Posterior Instrumentation and Arthrodesis: When is Anterior Release Indicated?

Cited by 70 publications

References 37 publications

Posterior fusion only for thoracic adolescent idiopathic scoliosis of more than 80°: pedicle screws versus hybrid instrumentation

Posterior fusion only for thoracic adolescent idiopathic scoliosis of more than 80°: pedicle screws versus hybrid instrumentation

Comment regarding “Is anterior release effective to increase flexibility in idiopathic thoracic scoliosis? Assessment by traction films” (A. Hempfing et al.)

Idiopathic Scoliosis

Contact Info

Product

Resources

About