Three-dimensional analysis of spinal deformity correction in adolescent idiopathic scoliosis: comparison of two distinct techniques

Sikora‐Klak, Jakub; Upasani, Vidyadhar V.; Ilharreborde, Brice; Cross, Madeline; Bastrom, Tracey P.; Mazda, Keyvan; Yaszay, Burt; Newton, Peter O.

doi:10.1007/s00381-020-04868-0

Cited by 5 publications

(5 citation statements)

References 34 publications

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“…There is moderate evidence that the instrumentation affects surgical outcomes. Sikora-Klak et al [75] reported that the use of all-screw instrumentation was associated with significantly better coronal correction and slightly better restoration of TK when compared to hybrid constructs, while Kato et al [76] reported greater axial correction using all-screw systems. However, both studies did not adjust for preoperative curve parameters, which were unequal between the case-control groups, and other surgical factors were not accounted for.…”

Section: Type Of Instrumentationmentioning

confidence: 99%

“…Studies comparing outcomes of current systems [75,76] had a generally moderate risk of bias due to important unadjusted factors such as the operating surgeon, fusion length, and baseline patient characteristics. Ilharreborde et al [35,81] have extensively reported on the postoperative correction rates of posteromedial translation with sublaminar bands, which shows satisfactory correction in hypokyphotic patients.…”

Section: Surgical Factorsmentioning

confidence: 99%

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Patient and surgical predictors of 3D correction in posterior spinal fusion: a systematic review

Wan

Wong

et al. 2023

Eur Spine J

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Background Restoration of three-dimensional (3D) alignment is critical in correcting patients with adolescent idiopathic scoliosis using posterior spinal fusion (PSF). However, current studies mostly rely on 2D radiographs, resulting in inaccurate assessment of surgical correction and underlying predictive factors. While 3D reconstruction of biplanar radiographs is a reliable and accurate tool for quantifying spinal deformity, no study has reviewed the current literature on its use in evaluating surgical prognosis. Purpose To summarize the current evidence on patient and surgical factors affecting sagittal alignment and curve correction after PSF based on 3D parameters derived from reconstruction of biplanar radiographs. Methods A comprehensive search was conducted by three independent investigators on Medline, PubMed, Web of Science, and Cochrane Library to obtain all published information on predictors of postoperative alignment and correction after PSF. Search items included "adolescent idiopathic scoliosis," "stereoradiography," "three-dimensional," "surgical,” and "correction." The inclusion and exclusion criteria were carefully defined to include clinical studies. Risk of bias was assessed with the Quality in Prognostic Studies tool, and level of evidence for each predictor was rated with the Grading of Recommendations, Assessment, Development, and Evaluations approach. 989 publications were identified, with 444 unique articles subjected to full-text screening. Ultimately, 41 articles were included. Results Strong predictors of better curve correction included preoperative normokyphosis (TK > 15°), a corresponding rod contour, intraoperative vertebral rotation and translation, and upper and lower instrumented vertebrae selected based on sagittal and axial inflection points. For example, for Lenke 1 patients with junctional vertebrae above L1, fusion to NV-1 (1 level above the neutral vertebra) achieved optimal curve correction while preserving motion segments. Pre-op coronal Cobb angle and axial rotation, distal junctional kyphosis, pelvic incidence, sacral slope, and type of instrument were identified as predictors with moderate evidence. For Lenke 1C patients, > 50% LIV rotation was found to increase spontaneous lumbar curve correction. Pre-op thoracolumbar apical translation and lumbar lordosis, Ponte osteotomies, and rod material were found to be predictors with low evidence. Conclusions Rod contouring and UIV/LIV selection should be based on preoperative 3D TK in order to achieve normal postoperative alignment. Specifically, Lenke 1 patients with high-lying rotations should be fused distally at NV-1, while hypokyphotic patients with large lumbar curves and truncal shift should be fused at NV to improve lumbar alignment. Lenke 1C curves should be corrected using > 50% LIV rotation counterclockwise to the lumbar rotation. Further investigation should compare surgical correction between pedicle-screw and hybrid constructs using matched cohorts. DJK and overbending rods are potential predictors of postoperative alignment.

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Section: Type Of Instrumentationmentioning

confidence: 99%

Section: Surgical Factorsmentioning

confidence: 99%

Patient and surgical predictors of 3D correction in posterior spinal fusion: a systematic review

Wan

Wong

et al. 2023

Eur Spine J

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“…All-pedicle screw constructs have become the gold standard for AIS posterior fusion, but hybrid techniques using thoracic sublaminar bands have also proved their efficacy for deformity correction, emphasizing the sagittal alignment restoration in hypokyphotic patients. 1 – 3 Our department has a long experience with the bands, used since 2005, and the constructs have progressively evolved over time. 4 Sublaminar bands are no longer recommended at lumbar levels, except in the very dystrophic pedicles that can be found in some syndromic patients, and they are mainly used now from T5 to T10 in AIS, mostly on the concave side.…”

Section: Introductionmentioning

confidence: 99%

“…While frontal correction rates have been for long very satisfactory, ranging from 50% to 70% in the recent literature, the clinical axial correction, observed both intraoperatively and postoperatively with the residual rib hump, sometimes remained disappointing. 1 – 3 , 5 – 7 One of the solutions found was “the double rod frame technique,” described in 2019, in which the contact of the right rod on the apical convex lamina during the concave translation helped emphasize the axial correction, which reached 42%. 5 The second alternative that gained popularity among some surgeons was the replacement of the convex sublaminar bands by periapical uniplanar screws, to increase the implant density and allow a more direct vertebral derotation from the convex side, after having performed the posteromedial translation on the concave rod.…”

Section: Introductionmentioning

confidence: 99%

Does the addition of convex uniplanar screws in hybrid constructs improve 3D surgical correction in thoracic adolescent idiopathic scoliosis posterior fusion?

Simon,

Finoco,

Julien-Marsollier

et al. 2024

Journal of Children's Orthopaedics

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Purpose: Hybrid techniques using thoracic sublaminar bands have proved their efficacy in adolescent idiopathic scoliosis posterior fusion, but clinical axial correction sometimes remained disappointing. One solution found was “the frame technique” and the second alternative was the replacement of the convex sublaminar bands by periapical uniplanar screws. The goal of this study was to compare clinical and radiological outcomes of both techniques in a consecutive cohort of adolescent idiopathic scoliosis patients. Methods: All patients undergoing primary posterior fusion for thoracic adolescent idiopathic scoliosis between January 2017 and March 2020 were included. Two groups were compared: Group 1 with thoracic sublaminar bands only and Group 2 with periapical uniplanar screws. All patients underwent standing stereoradiographs. The main frontal, sagittal, and axial (apical vertebra rotation) radiological parameters of interest were analyzed. Functional outcomes were assessed using the Scoliosis Research Society 30 score. Results: A total of 147 adolescents were included (Group 1, n = 73 and Group 2, n = 74 patients). In the frontal plane, a greater reduction index was observed in Group 2 (68% versus 62%, p < 0.001) as well as a better apical axial correction (67.8% versus 46.6%, p = 0.03). The number of thoracoplasty performed was reduced (6.7% versus 20.5%, p = 0.02) in Group 2, with a significant decrease in the rate of mechanical complication. No significant loss of correction was observed during follow-up in any of the group. Conclusion: The adjunction of convex uniplanar screws at the periapical levels improved the three-dimensional surgical correction of thoracic adolescent idiopathic scoliosis treated with hybrid constructs. Level of evidence: level III, retrospective comparative study

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“…Historically, AIS correction has presented several challenges. Achieving three-dimensional correction, especially in cases with complex curvature patterns, demands a nuanced surgical approach [ 17 ]. The surgery should not hinder spinal growth, especially in younger patients.…”

Section: Introductionmentioning

confidence: 99%

Assessment of the Efficacy of Low-Density Pedicle Screw Construction Correction of Adolescent Idiopathic Scoliosis: A Prospective Single-Center Study

Ebrahim Eladl,

Abdel-Samie Rabee,

Mohammed Taha

2023

Cureus

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Background Adolescent idiopathic scoliosis (AIS) poses physical and psychological challenges for affected individuals, necessitating effective and less invasive treatment approaches. This study aimed to evaluate the efficacy of low-density posterior pedicle screw fixation in AIS correction, exploring its impact on deformity parameters, patient quality of life, and potential complications. Methodology A prospective study involving 20 AIS patients, employing low-density pedicle screw fixation, was conducted. Clinical, radiological, and Scoliosis Research Society (SRS-22) outcomes were assessed. Data analysis was conducted using SPSS version 26 software (IBM Corp., Armonk, NY, USA). Results Significant reductions in major and minor curve Cobb angles were observed (mean major curve reduction: 79.14%, p < 0.001; mean minor curve reduction: 68.91%, p < 0.001), indicating substantial deformity correction. As measured by the SRS-22 questionnaire, quality of life showed noteworthy improvements (mean pain score increase: 0.54, p < 0.05; mean self-image score increase: 1.22, p < 0.01), reflecting enhanced patient satisfaction and well-being. Complications were documented in four (20%) cases, including infection, adding-on phenomenon, proximal junctional kyphosis, and thoracic hypokyphosis. Conclusions Our study highlights the efficacy of low-density pedicle screw constructs in AIS correction. Significant deformity reductions and improved quality of life underscore the success of the approach. However, long-term studies with larger cohorts are crucial for confirming durability.

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Three-dimensional analysis of spinal deformity correction in adolescent idiopathic scoliosis: comparison of two distinct techniques

Cited by 5 publications

References 34 publications

Patient and surgical predictors of 3D correction in posterior spinal fusion: a systematic review

Patient and surgical predictors of 3D correction in posterior spinal fusion: a systematic review

Does the addition of convex uniplanar screws in hybrid constructs improve 3D surgical correction in thoracic adolescent idiopathic scoliosis posterior fusion?

Assessment of the Efficacy of Low-Density Pedicle Screw Construction Correction of Adolescent Idiopathic Scoliosis: A Prospective Single-Center Study

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