Limits...
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) Pre-operative X-ray of dorsal, lumbar spine including lumbosacral junction (anteroposterior view) of a 15 year old female with rigid Lenke Type 4C curve having a major Cobb's angle is 104° (b) post-operative radiograph showing correction achieved with use of a three rod technique. Postoperative major Cobb's is 48°
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC2822417&req=5

Figure 0005: (a) Pre-operative X-ray of dorsal, lumbar spine including lumbosacral junction (anteroposterior view) of a 15 year old female with rigid Lenke Type 4C curve having a major Cobb's angle is 104° (b) post-operative radiograph showing correction achieved with use of a three rod technique. Postoperative major Cobb's is 48°

Mentions: Three patients with very large and stiff curves (over 100°) were treated with a three-rod technique [Figure 5] in addition to an anterior release. Stagnaras' wake-up test was utilized as the sole modality in 70 patients and subsequent patients (n=165) had a combination of wake up test and intra operative somatosensory evoked potentials (SSEP) monitoring, when the facility became available to us. A total of 201 patients had autograft sourced from the ribs resected at thoracoplasty mixed with synthetic ceramic bone substitute in the ratio 1:1. In 34 patients autograft was harvested exclusively from the spinous processes, and laminae of the segments to be fused. Epidural analgesia was routinely used for post-op analgesia.11 Our postoperative strategy has been to ambulate the patient with a light weight TLSO brace when hook/ wire devices (n=70) are used and without brace when all screw constructs (n=165) are used. Ambulation starts on the third postoperative (PO) day and the patient is discharged between days five and 14. The percentage of correction was calculated in each group as well as sub groups. Comparative analysis was not performed in between groups because of the non uniformity of the curve type, severity and flexibility in each group and sub group, as well as the non randomization of the instrumentation and correction strategies employed. Results from this series with respect to pulmonary function test and rib generation have been published.1213


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

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

(a) Pre-operative X-ray of dorsal, lumbar spine including lumbosacral junction (anteroposterior view) of a 15 year old female with rigid Lenke Type 4C curve having a major Cobb's angle is 104° (b) post-operative radiograph showing correction achieved with use of a three rod technique. Postoperative major Cobb's is 48°
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 0005: (a) Pre-operative X-ray of dorsal, lumbar spine including lumbosacral junction (anteroposterior view) of a 15 year old female with rigid Lenke Type 4C curve having a major Cobb's angle is 104° (b) post-operative radiograph showing correction achieved with use of a three rod technique. Postoperative major Cobb's is 48°
Mentions: Three patients with very large and stiff curves (over 100°) were treated with a three-rod technique [Figure 5] in addition to an anterior release. Stagnaras' wake-up test was utilized as the sole modality in 70 patients and subsequent patients (n=165) had a combination of wake up test and intra operative somatosensory evoked potentials (SSEP) monitoring, when the facility became available to us. A total of 201 patients had autograft sourced from the ribs resected at thoracoplasty mixed with synthetic ceramic bone substitute in the ratio 1:1. In 34 patients autograft was harvested exclusively from the spinous processes, and laminae of the segments to be fused. Epidural analgesia was routinely used for post-op analgesia.11 Our postoperative strategy has been to ambulate the patient with a light weight TLSO brace when hook/ wire devices (n=70) are used and without brace when all screw constructs (n=165) are used. Ambulation starts on the third postoperative (PO) day and the patient is discharged between days five and 14. The percentage of correction was calculated in each group as well as sub groups. Comparative analysis was not performed in between groups because of the non uniformity of the curve type, severity and flexibility in each group and sub group, as well as the non randomization of the instrumentation and correction strategies employed. Results from this series with respect to pulmonary function test and rib generation have been published.1213

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