Limits...
Adolescent idiopathic scoliosis (AIS) treated with arthrodesis and posterior titanium instrumentation: 8 to 12 years follow up without late infection.

Mueller FJ, Gluch H - Scoliosis (2009)

Bottom Line: The clinical results were recorded by means of the SRS 24 questionnaire.In the frontal plane, the mean pre-operative thoracic and lumbar curve had been 62.4 degrees and 43.5 degrees respectively, post-operatively the curves were reduced to 26.9 degrees and 16.3 degrees , resulting in a correction rate of 56.9% for thoracic and 62.5% for lumbar curve.Posterior titanium instrumentation is a safe and effective procedure in the surgical correction of AIS.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Spinal Surgery and Scoliosis Center, Behandlungszentrum Vogtareuth, Germany. muellerfj5@aol.com

ABSTRACT

Background: There are no data in the peer-reviewed literature regarding long term results in patients treated for AIS with a posterior titanium instrumentation. Therefore we assessed the outcome in 50 patients treated by titanium implant.

Methods: A total of 50 patients with a mean age of 16.6 years were treated. In all patients, titanium hooks and pedicle screws were used in combination. The demographic data and the pre- and post-operative radiographs of all 50 patients were re-examined, and 49 of the 50 patients (98%) attended a radiological and clinical follow up-examination on average 10.1 years post-operatively. The clinical results were recorded by means of the SRS 24 questionnaire.

Results: In the frontal plane, the mean pre-operative thoracic and lumbar curve had been 62.4 degrees and 43.5 degrees respectively, post-operatively the curves were reduced to 26.9 degrees and 16.3 degrees , resulting in a correction rate of 56.9% for thoracic and 62.5% for lumbar curve. At the follow up-evaluation, the Cobb angle of the thoracic and lumbar curve was 31.0 degrees and 21.3 degrees respectively, giving a final correction rate of 50.3% for thoracic, and 51.0% for lumbar curve. 7 of the 50 patients (14.3%) had undergo revision surgery for complications, but complete implant removal was necessary in only one case. Analysis of the SRS 24 questionnaire showed an average score of 95.8 points.

Conclusion: Posterior titanium instrumentation is a safe and effective procedure in the surgical correction of AIS. In this retrospective study with small patient number, it shows favourable long-term results; in particular, the loss of correction is low, no late infection occurred and there was a very high survival rate of the implant itself.

No MeSH data available.


Related in: MedlinePlus

Instrumentation system WSI Titan, an over the top loading system with screws and hooks.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC2734567&req=5

Figure 1: Instrumentation system WSI Titan, an over the top loading system with screws and hooks.

Mentions: The implant is a double rod system made of pure titanium rods with a diameter of 6 or 7 mm, respectively, which allows segmental fixation through lamina hooks and/or conical pedicle screws fabricated from TiAl6V4 alloy. It is a "over the top" loading system (Figure 1). The indication for operation was progression of the AIS with a main curve of over 45° in the frontal plane. Anterior release to mobilize a rigid main curve was not an exclusion criterion. No additional procedures such as rib osteotomy were performed in any of the patients. For preparation and mobilization for the operation, all patients carried out Cotrel self-extension over a period of 2 to 3 weeks. All patients received a perioperative antibiotic prophylaxis with intravenous cephalosporin. All operative procedures were performed by the senior author (H.G.). The operative procedure involved mobilization of the scoliosis by resection of the spinous processes, decortication of the laminae, facet joint cleaning and division of the ligamentum flavum on the concave side of the curvature. The scoliosis was then corrected by inserting the hooks and pedicle screws with loading of the two anatomically shaped vertical rods with rotation in situ and additional compression or distraction of segments as needed. The fifth lumbar vertebra or the sacrum were spared from fusion in all cases. A transverse connector was placed between the cranial and caudal ends of the two vertical rods, respectively, in all patients. A wake up test was performed after insertion of the vertical rod on the concave side to assess the neurological function intra-operatively. For spondylodesis only local bone material reduced to chips was utilized. All patients received autologous blood with or without cell saver, no patient received non- autologous blood products. All patients were mobilized routinely without a corset. Instrumentation with the titanium implant was performed in all cases. Additionally, 9 of 50 patients had anterior release pre-operatively because of a severe main thoracic curve (average 81°, range 71° to 111°).


Adolescent idiopathic scoliosis (AIS) treated with arthrodesis and posterior titanium instrumentation: 8 to 12 years follow up without late infection.

Mueller FJ, Gluch H - Scoliosis (2009)

Instrumentation system WSI Titan, an over the top loading system with screws and hooks.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2734567&req=5

Figure 1: Instrumentation system WSI Titan, an over the top loading system with screws and hooks.
Mentions: The implant is a double rod system made of pure titanium rods with a diameter of 6 or 7 mm, respectively, which allows segmental fixation through lamina hooks and/or conical pedicle screws fabricated from TiAl6V4 alloy. It is a "over the top" loading system (Figure 1). The indication for operation was progression of the AIS with a main curve of over 45° in the frontal plane. Anterior release to mobilize a rigid main curve was not an exclusion criterion. No additional procedures such as rib osteotomy were performed in any of the patients. For preparation and mobilization for the operation, all patients carried out Cotrel self-extension over a period of 2 to 3 weeks. All patients received a perioperative antibiotic prophylaxis with intravenous cephalosporin. All operative procedures were performed by the senior author (H.G.). The operative procedure involved mobilization of the scoliosis by resection of the spinous processes, decortication of the laminae, facet joint cleaning and division of the ligamentum flavum on the concave side of the curvature. The scoliosis was then corrected by inserting the hooks and pedicle screws with loading of the two anatomically shaped vertical rods with rotation in situ and additional compression or distraction of segments as needed. The fifth lumbar vertebra or the sacrum were spared from fusion in all cases. A transverse connector was placed between the cranial and caudal ends of the two vertical rods, respectively, in all patients. A wake up test was performed after insertion of the vertical rod on the concave side to assess the neurological function intra-operatively. For spondylodesis only local bone material reduced to chips was utilized. All patients received autologous blood with or without cell saver, no patient received non- autologous blood products. All patients were mobilized routinely without a corset. Instrumentation with the titanium implant was performed in all cases. Additionally, 9 of 50 patients had anterior release pre-operatively because of a severe main thoracic curve (average 81°, range 71° to 111°).

Bottom Line: The clinical results were recorded by means of the SRS 24 questionnaire.In the frontal plane, the mean pre-operative thoracic and lumbar curve had been 62.4 degrees and 43.5 degrees respectively, post-operatively the curves were reduced to 26.9 degrees and 16.3 degrees , resulting in a correction rate of 56.9% for thoracic and 62.5% for lumbar curve.Posterior titanium instrumentation is a safe and effective procedure in the surgical correction of AIS.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Spinal Surgery and Scoliosis Center, Behandlungszentrum Vogtareuth, Germany. muellerfj5@aol.com

ABSTRACT

Background: There are no data in the peer-reviewed literature regarding long term results in patients treated for AIS with a posterior titanium instrumentation. Therefore we assessed the outcome in 50 patients treated by titanium implant.

Methods: A total of 50 patients with a mean age of 16.6 years were treated. In all patients, titanium hooks and pedicle screws were used in combination. The demographic data and the pre- and post-operative radiographs of all 50 patients were re-examined, and 49 of the 50 patients (98%) attended a radiological and clinical follow up-examination on average 10.1 years post-operatively. The clinical results were recorded by means of the SRS 24 questionnaire.

Results: In the frontal plane, the mean pre-operative thoracic and lumbar curve had been 62.4 degrees and 43.5 degrees respectively, post-operatively the curves were reduced to 26.9 degrees and 16.3 degrees , resulting in a correction rate of 56.9% for thoracic and 62.5% for lumbar curve. At the follow up-evaluation, the Cobb angle of the thoracic and lumbar curve was 31.0 degrees and 21.3 degrees respectively, giving a final correction rate of 50.3% for thoracic, and 51.0% for lumbar curve. 7 of the 50 patients (14.3%) had undergo revision surgery for complications, but complete implant removal was necessary in only one case. Analysis of the SRS 24 questionnaire showed an average score of 95.8 points.

Conclusion: Posterior titanium instrumentation is a safe and effective procedure in the surgical correction of AIS. In this retrospective study with small patient number, it shows favourable long-term results; in particular, the loss of correction is low, no late infection occurred and there was a very high survival rate of the implant itself.

No MeSH data available.


Related in: MedlinePlus