Thoracoscopic Spinal Fusion Compared with Posterior Spinal Fusion for the Treatment of Thoracic Adolescent Idiopathic Scoliosis

Lonner, Baron S.; Kondrachov, Dimitry; Siddiqi, Farhan; Hayes, Victor; Scharf, Carrie

doi:10.2106/jbjs.e.00001

Cited by 87 publications

(24 citation statements)

References 57 publications

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“…VATS on adolescent idiopathic scoliosis has the advantages of an open anterior surgery while offering the potential of decreased impact on pulmonary function, improved visualization of the spine with enhanced access to the extremes of the curve, decreased post-operative pain, and improved cosmesis as a result of the use of small incisions 3-5,13-15. Recently, indications for VATS has been extended to thoracolumbar junction scoliosis16 or even thoracoplasty 1.…”

Section: Discussionmentioning

confidence: 99%

“…The basic technique of thoracoscopic surgery involving the insertion of thoracoscopic portals, pleural dissection, discectomies, and screw insertion were performed in the same way as described in other previous reports on the thoracoscopic management of AIS 13,14. Bony fusion was carried out by packing a morselized iliac crest bone graft into the disc space.…”

Section: Methodsmentioning

confidence: 99%

“…Bony fusion was carried out by packing a morselized iliac crest bone graft into the disc space. In the thin rod group, the cantilever technique was used to achieve correction as described by Lonner, et al,13 which involved prebending the contoured thin rod to the desired level of post-operative scoliosis and kyphosis, with sequential loading into the screws from proximal to distal and secured with locking nuts. In the thick rod group, once the screws were inserted, a rod was cut to the appropriate length and contoured so that it would easily pass through all of the poly-axial screw heads.…”

Section: Methodsmentioning

confidence: 99%

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Video-Assisted Thoracoscopic Surgery for Correction of Adolescent Idiopatic Scoliosis: Comparison of 4.5 mm versus 5.5 mm Rod Constructs

et al. 2010

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PurposeThe purpose of this study is to report the comparative results of thoracoscopic correction achieved via cantilever technique using a 4.5 mm thin rod and the poly-axial reduction screw technique using a 5.5 mm thick rod in Lenke type 1 adolescent idiopathic scoliosis (AIS).Materials and MethodsRadiographic data, Scoliosis Research Society (SRS) patient-based outcome questionnaires, and operative records were reviewed for forty-nine patients undergoing surgical treatment of scoliosis. The study group was divided into a 4.5 mm thin rod group (n = 24) and a 5.5 mm thick rod group (n = 25). The radiographic parameters that were analyzed included coronal curve correction, the most caudal instrumented vertebra tilt angle correction, coronal balance, and thoracic kyphosis.ResultsThe major curve was corrected from 49.8° and 47.2° pre-operatively to 24.5° and 18.8° at the final follow-up for the thin and thick rod groups, respectively (50.8% vs. 60.2% correction). There were no significant differences between the two groups in terms of kyphosis, coronal balance, or tilt angle at the time of the final follow-up. The mean number of levels fused was 6.2 in the thin rod group, compared with 5.9 levels in the thick rod group. There were no major intraoperative complications in either group.ConclusionSignificant correction loss was observed in the thin rod system at the final follow-up though both groups had comparable correction immediately post-operative. Therefore, the thick rod with poly axial screw system helps to maintain post-operative correction.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Video-Assisted Thoracoscopic Surgery for Correction of Adolescent Idiopatic Scoliosis: Comparison of 4.5 mm versus 5.5 mm Rod Constructs

et al. 2010

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“…Pulmonary function following VATS, although significantly preserved initially has been comparable to open surgery at final followup 58. In addition, this technique has a steep learning curve for the surgeon and requires instruments that are not available in every Spinal Center.…”

Section: Surgical Considerationsmentioning

confidence: 99%

Current concepts and controversies on adolescent idiopathic scoliosis: Part II

Sud

2013

IJOO

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A new era in the surgical treatment of adolescent idiopathic scoliosis (AIS) opened with the introduction of pedicle screw instrumentation, which provides 3-column vertebral fixation and allows major deformity correction on the coronal, sagittal, and axial planes. A steep learning curve can be expected for spinal surgeons to become familiar with pedicle screw placement and correction techniques. Potential complications including injury to adjacent neural, vascular, and visceral structures can occur due to screw misplacement or pull-out during correction maneuvers. These major complications are better recognized as pedicle screw techniques become more popular and may result in serious morbidity and mortality. Extensive laboratory and clinical training is mandatory before pedicle screw techniques in scoliosis surgery are put to practice. Wider application, especially in developing countries, is limited by the high cost of implants. Refined correction techniques are currently developed and these utilize a lesser number of pedicle anchors which are strategically positioned to allow optimum deformity correction while reducing the neurological risk, surgical time, and blood loss, as well as instrumentation cost. Such techniques can be particularly attractive at a time when cost has major implications on provision of health care as they can make scoliosis treatment available to a wider population of patients. Pedicle screw techniques are currently considered the gold standard for scoliosis correction due to their documented superior biomechanical properties and ability to produce improved clinical outcomes as reflected by health-related quality-of-life questionnaires. Ongoing research promises further advances with the future of AIS treatment incorporating genetic counseling and possibly fusionless techniques.

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“…The rate of neurovascular complications associated with pedicle screw misplacement varies from 0% to 1.3% (Liljenqvist et al 1997, Belmont et al 2001 Suk et al 2001, Coe et al 2006, Upendra et al 2008). Evolution of the operative techniques since 1995 (Suk et al 1995, Kim and Lenke 2005, Kuklo et al 2005, Lonner et al 2006), our better understanding of the 3-dimensional nature of adolescent idiopathic scoliosis (AIS), and probably the advances in multidetector computed tomography (CT) technology—with the availability of modern CTs that enable dose reduction—have contributed to increasing use of the “pedicle screw-only construct” in the surgical correction of scoliosis.…”

mentioning

confidence: 99%

The rate of screw misplacement in segmental pedicle screw fixation in adolescent idiopathic scoliosis

Abul-Kasim¹,

Ohlin²

2010

Acta Orthopaedica

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Background and purpose There are no reports in the literature on the influence of learning on the pedicle screw insertion. We studied the effect of learning on the rate of screw misplacement in patients with adolescent idiopathic scoliosis treated with segmental pedicle screw fixation.Method We retrospectively evaluated low-dose spine computed tomography of 116 consecutive patients (aged 16 (12–24) years, 94 females) who were operated during 4 periods over 2005–2009 (group 1: patients operated autumn 2005–2006; group 2: 2007; group 3: 2008; and group 4: 2009). 5 types of misplacement were recorded: medial cortical perforation, lateral cortical perforation, anterior cortical perforation of the vertebral body, endplate perforation, and perforation of the neural foramen.Reslts 2,201 pedicle screws were evaluated, with an average of 19 screws per patient. The rate of screw misplacement for the whole study was 14%. The rate of lateral and medial cortical perforation was 7% and 5%. There was an inverse correlation between the occurrence of misplacement and the patient number, i.e. the date of operation (r = –0.35; p < 0.001). The skillfulness of screw insertion improved with reduction of the rate of screw misplacement from 20% in 2005–2006 to 11% in 2009, with a breakpoint at the end of the first study period (34 patients).Interpretation We found a substantial learning curve; cumulative experience may have contributed to continued reduction of misplacement rate.

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Thoracoscopic Spinal Fusion Compared with Posterior Spinal Fusion for the Treatment of Thoracic Adolescent Idiopathic Scoliosis

Cited by 87 publications

References 57 publications

Video-Assisted Thoracoscopic Surgery for Correction of Adolescent Idiopatic Scoliosis: Comparison of 4.5 mm versus 5.5 mm Rod Constructs

Video-Assisted Thoracoscopic Surgery for Correction of Adolescent Idiopatic Scoliosis: Comparison of 4.5 mm versus 5.5 mm Rod Constructs

Current concepts and controversies on adolescent idiopathic scoliosis: Part II

The rate of screw misplacement in segmental pedicle screw fixation in adolescent idiopathic scoliosis

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