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Morbidity and radiographic outcomes of severe scoliosis of 90° or more: a comparison of hybrid with total pedicle screw instrumentation.

Helenius I, Mattila M, Jalanko T - J Child Orthop (2014)

Bottom Line: The follow-up time averaged 2.9 (2.0-6.6) years for radiographic and quality of life measurements and 5.5 years (2.0-9.0) years for mortality data.Of these patients, one had adolescent idiopathic scoliosis, three secondary scoliosis, and 28 neuromuscular scoliosis.One (3.1 %) patient died during follow-up for severe pneumonia.

View Article: PubMed Central - PubMed

Affiliation: Department of Paediatric Orthopaedic Surgery, Turku University Central Hospital, Kiinamyllynkatu 4-8, 21520, Turku, Finland, ilkka.helenius@helsinki.fi.

ABSTRACT

Objectives: Untreated severe scoliosis is associated with increased mortality and remains a significant surgical challenge. Few studies have reported mortality after the surgical treatment of severe scoliosis beyond a 2-year follow-up. The objectives of this study were to evaluate mortality beyond standard 2-year follow-up and compare radiographic outcomes using hybrid or pedicle screw instrumentation for severe scoliosis.

Methods: We evaluated 32 consecutive patients [11 males, mean age at surgery 15.3 (range 10.7-20.7) years] operated for a scoliosis of 90° or more using either hybrid (n = 15) or pedicle screw (n = 17) instrumentation. The follow-up time averaged 2.9 (2.0-6.6) years for radiographic and quality of life measurements and 5.5 years (2.0-9.0) years for mortality data. Of these patients, one had adolescent idiopathic scoliosis, three secondary scoliosis, and 28 neuromuscular scoliosis. Twelve patients in the hybrid and two patients in the pedicle screw groups underwent anteroposterior surgery (p < 0.001), and three patients in both groups had an apical vertebral column resection.

Results: One (3.1 %) patient died during follow-up for severe pneumonia. Preoperatively, the mean magnitude of the major curve was 109° (90°-127°) in the hybrid and 100° (90°-116°) in the pedicle screw groups (p = 0.015), and was corrected to 45° (19°-69°) in the hybrid and 27° (18°-40°) in the pedicle screw groups at the 2-year follow-up (p < 0.001), with a mean correction of the major curve of 59 % (37-81 %) in the hybrid versus 73 % (60-81 %) in the pedicle screw groups, respectively (p = 0.0023). There were six postoperative complications, including one transient spinal cord deficit necessitating reoperation in the hybrid group as compared with five complications in the pedicle screw group (p = 0.53).

Conclusions: The mid-term mortality rate after the surgical treatment of severe scoliosis was low. Severe scoliosis can be treated safely with significantly better correction of the spinal deformity using pedicle screws than hybrid instrumentation.

No MeSH data available.


Related in: MedlinePlus

14-year-old boy with cerebral palsy (CP; spastic tetraparesis) and severe neuromuscular scoliosis. Anteroposterior spinal deformity correction with hybrid instrumentation provided excellent and stable correction at the 2-year follow-up
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Fig1: 14-year-old boy with cerebral palsy (CP; spastic tetraparesis) and severe neuromuscular scoliosis. Anteroposterior spinal deformity correction with hybrid instrumentation provided excellent and stable correction at the 2-year follow-up

Mentions: The mean preoperative Cobb angle of the major curve was 109° (range 90°–127°) in the hybrid group and 100° (90–116°) in the pedicle screw group (p = 0.015) (Table 1). The preoperative flexibility of the major curves in traction radiographs was similar in the study groups (29 ± 12 % in the hybrid vs. 33 ± 14 % in the pedicle screw group). The magnitude and correction of the major curve was significantly better in the pedicle screw group as compared with the hybrid group at the immediate postoperative (p = 0.0010 and p = 0.0044), 6 months (p < 0.001 and p = 0.0017), and 2-year postoperative radiographs (p < 0.001 and p = 0.0023) (Table 2). The average major curve corrections at 2 years were 59 % (range 37–81 %) for the hybrid and 73 % (range 60–81 %) for the pedicle screw groups, respectively (p = 0.0023) (Fig. 1).Table 2


Morbidity and radiographic outcomes of severe scoliosis of 90° or more: a comparison of hybrid with total pedicle screw instrumentation.

Helenius I, Mattila M, Jalanko T - J Child Orthop (2014)

14-year-old boy with cerebral palsy (CP; spastic tetraparesis) and severe neuromuscular scoliosis. Anteroposterior spinal deformity correction with hybrid instrumentation provided excellent and stable correction at the 2-year follow-up
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4128946&req=5

Fig1: 14-year-old boy with cerebral palsy (CP; spastic tetraparesis) and severe neuromuscular scoliosis. Anteroposterior spinal deformity correction with hybrid instrumentation provided excellent and stable correction at the 2-year follow-up
Mentions: The mean preoperative Cobb angle of the major curve was 109° (range 90°–127°) in the hybrid group and 100° (90–116°) in the pedicle screw group (p = 0.015) (Table 1). The preoperative flexibility of the major curves in traction radiographs was similar in the study groups (29 ± 12 % in the hybrid vs. 33 ± 14 % in the pedicle screw group). The magnitude and correction of the major curve was significantly better in the pedicle screw group as compared with the hybrid group at the immediate postoperative (p = 0.0010 and p = 0.0044), 6 months (p < 0.001 and p = 0.0017), and 2-year postoperative radiographs (p < 0.001 and p = 0.0023) (Table 2). The average major curve corrections at 2 years were 59 % (range 37–81 %) for the hybrid and 73 % (range 60–81 %) for the pedicle screw groups, respectively (p = 0.0023) (Fig. 1).Table 2

Bottom Line: The follow-up time averaged 2.9 (2.0-6.6) years for radiographic and quality of life measurements and 5.5 years (2.0-9.0) years for mortality data.Of these patients, one had adolescent idiopathic scoliosis, three secondary scoliosis, and 28 neuromuscular scoliosis.One (3.1 %) patient died during follow-up for severe pneumonia.

View Article: PubMed Central - PubMed

Affiliation: Department of Paediatric Orthopaedic Surgery, Turku University Central Hospital, Kiinamyllynkatu 4-8, 21520, Turku, Finland, ilkka.helenius@helsinki.fi.

ABSTRACT

Objectives: Untreated severe scoliosis is associated with increased mortality and remains a significant surgical challenge. Few studies have reported mortality after the surgical treatment of severe scoliosis beyond a 2-year follow-up. The objectives of this study were to evaluate mortality beyond standard 2-year follow-up and compare radiographic outcomes using hybrid or pedicle screw instrumentation for severe scoliosis.

Methods: We evaluated 32 consecutive patients [11 males, mean age at surgery 15.3 (range 10.7-20.7) years] operated for a scoliosis of 90° or more using either hybrid (n = 15) or pedicle screw (n = 17) instrumentation. The follow-up time averaged 2.9 (2.0-6.6) years for radiographic and quality of life measurements and 5.5 years (2.0-9.0) years for mortality data. Of these patients, one had adolescent idiopathic scoliosis, three secondary scoliosis, and 28 neuromuscular scoliosis. Twelve patients in the hybrid and two patients in the pedicle screw groups underwent anteroposterior surgery (p < 0.001), and three patients in both groups had an apical vertebral column resection.

Results: One (3.1 %) patient died during follow-up for severe pneumonia. Preoperatively, the mean magnitude of the major curve was 109° (90°-127°) in the hybrid and 100° (90°-116°) in the pedicle screw groups (p = 0.015), and was corrected to 45° (19°-69°) in the hybrid and 27° (18°-40°) in the pedicle screw groups at the 2-year follow-up (p < 0.001), with a mean correction of the major curve of 59 % (37-81 %) in the hybrid versus 73 % (60-81 %) in the pedicle screw groups, respectively (p = 0.0023). There were six postoperative complications, including one transient spinal cord deficit necessitating reoperation in the hybrid group as compared with five complications in the pedicle screw group (p = 0.53).

Conclusions: The mid-term mortality rate after the surgical treatment of severe scoliosis was low. Severe scoliosis can be treated safely with significantly better correction of the spinal deformity using pedicle screws than hybrid instrumentation.

No MeSH data available.


Related in: MedlinePlus