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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

(a) Preoperative X-ray of dorsolumbar and sacral spine (anteroposterior view) of a 12 year old female with Lenke Type1C curve. (b) Post-operative radiograph depicting hybrid constructs with screws at the bottom and hook-claws at the top and sublaminar wires at the concave apex, resulting in a good correction
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Figure 0002: (a) Preoperative X-ray of dorsolumbar and sacral spine (anteroposterior view) of a 12 year old female with Lenke Type1C curve. (b) Post-operative radiograph depicting hybrid constructs with screws at the bottom and hook-claws at the top and sublaminar wires at the concave apex, resulting in a good correction

Mentions: The instrumentation systems employed matched the evolution of the various systems and their availability in the country. Hybrid constructs (Hook, screw, sublaminar wires) were employed in 70 patients [Figure 2] and 118 patients received all pedicle screw instrumented corrections [Figure 3]. As the expertise in accurately inserting pedicle screws into the deformed thoracic pedicle improved, more cases were corrected employing the “all screw” constructs. The 47 anterior corrections utilized the screw and staple system with single rigid rod constructs [Figure 4]. The correction maneuvers employed were transverse translation with rod rotation in the earlier hybrid systems which were later on adapted to a combination of transverse translation, rod rotation and direct vertebral rotation in the “all pedicle screws” constructs. Convex side compression is additionally performed in anterior corrections and posterior corrections of lumbar curves. Segmental derotation was performed for transverse plane correction in all cases where an appropriate implant construct allowed it. Thoracoplasty was performed electively in 198 patients (since we regularly use rib grafts for fusion and rarely was iliac crest graft harvested) and later on it was performed only if deemed necessary (3 out of the 37 cases), after corrective maneuvers; this change in strategy was more so after the introduction of all pedicle screw systems.


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

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

(a) Preoperative X-ray of dorsolumbar and sacral spine (anteroposterior view) of a 12 year old female with Lenke Type1C curve. (b) Post-operative radiograph depicting hybrid constructs with screws at the bottom and hook-claws at the top and sublaminar wires at the concave apex, resulting in a good correction
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 0002: (a) Preoperative X-ray of dorsolumbar and sacral spine (anteroposterior view) of a 12 year old female with Lenke Type1C curve. (b) Post-operative radiograph depicting hybrid constructs with screws at the bottom and hook-claws at the top and sublaminar wires at the concave apex, resulting in a good correction
Mentions: The instrumentation systems employed matched the evolution of the various systems and their availability in the country. Hybrid constructs (Hook, screw, sublaminar wires) were employed in 70 patients [Figure 2] and 118 patients received all pedicle screw instrumented corrections [Figure 3]. As the expertise in accurately inserting pedicle screws into the deformed thoracic pedicle improved, more cases were corrected employing the “all screw” constructs. The 47 anterior corrections utilized the screw and staple system with single rigid rod constructs [Figure 4]. The correction maneuvers employed were transverse translation with rod rotation in the earlier hybrid systems which were later on adapted to a combination of transverse translation, rod rotation and direct vertebral rotation in the “all pedicle screws” constructs. Convex side compression is additionally performed in anterior corrections and posterior corrections of lumbar curves. Segmental derotation was performed for transverse plane correction in all cases where an appropriate implant construct allowed it. Thoracoplasty was performed electively in 198 patients (since we regularly use rib grafts for fusion and rarely was iliac crest graft harvested) and later on it was performed only if deemed necessary (3 out of the 37 cases), after corrective maneuvers; this change in strategy was more so after the introduction of all pedicle screw systems.

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