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Adolescent idiopathic scoliosis: Retrospective analysis of 235 surgically treated cases.

Unnikrishnan R, Renjitkumar J, Menon VK - Indian J Orthop (2010)

Bottom Line: The anterior corrections resulted in better correction of the AVT and trunk balance as compared to the posterior correction.The coronal plane correction was better when all screw constructs were employed.Use of all pedicle screw systems obviated the need for costoplasty in most cases.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics, Amrita Institute of Medical Sciences, Kochi, Kerala, India.

ABSTRACT

Background: The surgical treatment of adolescent idiopathic scoliosis (AIS) has taken great strides in the last two decades. There have been no long term reported studies on AIS from India with documented long term followup. In this study we review a single surgical team's series of 235 surgically treated cases of AIS with a follow-up from two to six years.

Materials and methods: Pre operative charts, radiographs and MRI scans for 235 patients were collected for this study. The patients were grouped into three groups where anterior correction and fusion (n=47), posterior correction and fusion (n=123) and combined anterior release and posterior instrumentation (n=65) was performed. Each group was divided into two subgroups based on the surgical approach and instrumentation strategy (all screw construct or hybrid construct) used. Patients were followed up for coronal and saggital plane corrections, apical vertebral translation (AVT), trunk balance and back pain. The percentage of correction was calculated in each group as well as sub groups.

Results: The incidence of MRI detected intraspinal anomaly in this series is 5.9% with 3.4% of them requiring neurosurgical procedure along with scoliosis correction. Average coronal major curve correction was 66% in the all screw group and 58.5% in the hybrid group. The coronal plane correction was better when the all screw constructs were employed. Also, the AVT and trunk balance was better with the all screw constructs. The anterior corrections resulted in better correction of the AVT and trunk balance as compared to the posterior correction. There were eight (3.4%) complications in this series. The coronal and saggital plane correction paralleled the published international standards.

Conclusion: The coronal plane correction was better when all screw constructs were employed. Use of all pedicle screw systems obviated the need for costoplasty in most cases. The increased incidence of intraspinal anomaly may warrant a routine pre operative MR imaging of all adolescent scoliosis needing surgical treatment.

No MeSH data available.


Related in: MedlinePlus

Measurement of trunk balance: X-ray of dorsal, lumbar spine including lumbosacral junction (anteroposterior view) showing a central sacral line (blue), vertical line (red) bisecting a line drawn from the peripheral edges of the ribs of the apical vertebra. The horizontal distance between the vertical lines (white) quantify the trunk imbalance
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Figure 0001: Measurement of trunk balance: X-ray of dorsal, lumbar spine including lumbosacral junction (anteroposterior view) showing a central sacral line (blue), vertical line (red) bisecting a line drawn from the peripheral edges of the ribs of the apical vertebra. The horizontal distance between the vertical lines (white) quantify the trunk imbalance

Mentions: Iliac crest ossification (Risser Index) has been routinely documented in all our cases. The thoracic apical vertebral translation was measured as the horizontal distance measured from the C7 plumbline to the midpoint of the apical vertebra/disc space; the distance for the lumbar AVT is measured from the central sacral line. To measure trunk balance, two vertical lines are drawn on a standing AP radiograph. The first line is the central sacral line and the second vertical line bisects a line drawn from the peripheral edges of the ribs of the apical vertebra. The horizontal distance between the vertical lines quantify the trunk imbalance6 [Figure 1]. This was repeated at three months, six months and then yearly. All the patients underwent pulmonary function test pre operatively and at three, six and 12 months postoperatively. The whole spine was screened by MRI in all patients as a routine pre operative imaging study. Indications for surgery was curve over 40° in children with significant growth remaining (Risser index, 0-2 and pre menarcheal) and curves over 50° in the skeletally mature child (especially in the lumbar spine) and clinically significant coronal plane decompensation of the spine.34 No standardized outcome instrument was used till 2004 (n=110); from 2005 (n=135) onwards the SRS 245 was administered pre operatively and at every follow up visit. The classification system employed was as described by King and Moe6 (n=110)till 2004. From 2005 onwards the scheme included the Lenke classification7 (n=135)as well as the Kings types.


Adolescent idiopathic scoliosis: Retrospective analysis of 235 surgically treated cases.

Unnikrishnan R, Renjitkumar J, Menon VK - Indian J Orthop (2010)

Measurement of trunk balance: X-ray of dorsal, lumbar spine including lumbosacral junction (anteroposterior view) showing a central sacral line (blue), vertical line (red) bisecting a line drawn from the peripheral edges of the ribs of the apical vertebra. The horizontal distance between the vertical lines (white) quantify the trunk imbalance
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2822417&req=5

Figure 0001: Measurement of trunk balance: X-ray of dorsal, lumbar spine including lumbosacral junction (anteroposterior view) showing a central sacral line (blue), vertical line (red) bisecting a line drawn from the peripheral edges of the ribs of the apical vertebra. The horizontal distance between the vertical lines (white) quantify the trunk imbalance
Mentions: Iliac crest ossification (Risser Index) has been routinely documented in all our cases. The thoracic apical vertebral translation was measured as the horizontal distance measured from the C7 plumbline to the midpoint of the apical vertebra/disc space; the distance for the lumbar AVT is measured from the central sacral line. To measure trunk balance, two vertical lines are drawn on a standing AP radiograph. The first line is the central sacral line and the second vertical line bisects a line drawn from the peripheral edges of the ribs of the apical vertebra. The horizontal distance between the vertical lines quantify the trunk imbalance6 [Figure 1]. This was repeated at three months, six months and then yearly. All the patients underwent pulmonary function test pre operatively and at three, six and 12 months postoperatively. The whole spine was screened by MRI in all patients as a routine pre operative imaging study. Indications for surgery was curve over 40° in children with significant growth remaining (Risser index, 0-2 and pre menarcheal) and curves over 50° in the skeletally mature child (especially in the lumbar spine) and clinically significant coronal plane decompensation of the spine.34 No standardized outcome instrument was used till 2004 (n=110); from 2005 (n=135) onwards the SRS 245 was administered pre operatively and at every follow up visit. The classification system employed was as described by King and Moe6 (n=110)till 2004. From 2005 onwards the scheme included the Lenke classification7 (n=135)as well as the Kings types.

Bottom Line: The anterior corrections resulted in better correction of the AVT and trunk balance as compared to the posterior correction.The coronal plane correction was better when all screw constructs were employed.Use of all pedicle screw systems obviated the need for costoplasty in most cases.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics, Amrita Institute of Medical Sciences, Kochi, Kerala, India.

ABSTRACT

Background: The surgical treatment of adolescent idiopathic scoliosis (AIS) has taken great strides in the last two decades. There have been no long term reported studies on AIS from India with documented long term followup. In this study we review a single surgical team's series of 235 surgically treated cases of AIS with a follow-up from two to six years.

Materials and methods: Pre operative charts, radiographs and MRI scans for 235 patients were collected for this study. The patients were grouped into three groups where anterior correction and fusion (n=47), posterior correction and fusion (n=123) and combined anterior release and posterior instrumentation (n=65) was performed. Each group was divided into two subgroups based on the surgical approach and instrumentation strategy (all screw construct or hybrid construct) used. Patients were followed up for coronal and saggital plane corrections, apical vertebral translation (AVT), trunk balance and back pain. The percentage of correction was calculated in each group as well as sub groups.

Results: The incidence of MRI detected intraspinal anomaly in this series is 5.9% with 3.4% of them requiring neurosurgical procedure along with scoliosis correction. Average coronal major curve correction was 66% in the all screw group and 58.5% in the hybrid group. The coronal plane correction was better when the all screw constructs were employed. Also, the AVT and trunk balance was better with the all screw constructs. The anterior corrections resulted in better correction of the AVT and trunk balance as compared to the posterior correction. There were eight (3.4%) complications in this series. The coronal and saggital plane correction paralleled the published international standards.

Conclusion: The coronal plane correction was better when all screw constructs were employed. Use of all pedicle screw systems obviated the need for costoplasty in most cases. The increased incidence of intraspinal anomaly may warrant a routine pre operative MR imaging of all adolescent scoliosis needing surgical treatment.

No MeSH data available.


Related in: MedlinePlus