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Spinal deformity progression after posterior segmental instrumentation and fusion for idiopathic scoliosis.

Upasani VV, Hedequist DJ, Hresko MT, Karlin LI, Emans JB, Glotzbecker MP - J Child Orthop (2015)

Bottom Line: At 2-years post-op, the patients in the deformity progression group had experienced a significantly greater change in upper instrumented vertebra (UIV) angulation, lower instrumented vertebra (LIV) angulation, and apical vertebral translation (AVT).Patients in the deformity progression group had a significantly greater difference between the lowest instrumented vertebra and stable vertebra compared to patients in the stable group (p = 0.001).Level III.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA, USA, vupasani@rchsd.org.

ABSTRACT

Study design: Retrospective chart and radiographic review.

Purpose: To assess the incidence of and variables associated with spinal deformity progression after posterior segmental instrumentation and fusion at a single institution. Progression of the scoliotic deformity after posterior instrumented spinal fusion has been described. Recent studies have concluded that segmental pedicle screw constructs are better able to control deformity progression.

Methods: Retrospective review of a consecutive series of idiopathic scoliosis patients (n = 89) with major thoracic curves (Lenke types 1-4) treated with posterior segmental instrumentation and fusion. Deformity progression was defined as a 10° increase in Cobb angle between the first-erect and 2-year post-operative radiographs. Clinical and radiographic data between the two cohorts (deformity progression versus stable) were analyzed to determine the variables associated with deformity progression.

Results: Patients in the deformity progression group (n = 13) tended to be younger (median 13.7 vs. 14.7 years) and experienced a significant change in height (p = 0.01) during the post-operative period compared to the stable group (n = 76). At 2-years post-op, the patients in the deformity progression group had experienced a significantly greater change in upper instrumented vertebra (UIV) angulation, lower instrumented vertebra (LIV) angulation, and apical vertebral translation (AVT). Two-year post-op Scoliosis Research Society questionnaire (SRS-22) scores in the appearance domain were also significantly worse in the deformity progression group. Patients in the deformity progression group had a significantly greater difference between the lowest instrumented vertebra and stable vertebra compared to patients in the stable group (p = 0.001).

Conclusions: Deformity progression after posterior spinal fusion does occur after modern segmental instrumentation. Segmental pedicle screw constructs do not prevent deformity progression. Skeletally immature patients with a significant growth potential are at the highest risk for deformity progression. In immature patients, extending the fusion distally to the stable vertebra may minimize deformity progression.

Level of evidence: Level III.

No MeSH data available.


Related in: MedlinePlus

A 12 years and 8 months old, Risser grade 0, pre-menarchal female with Lenke type 1B idiopathic scoliosis. Pre-operative posterior-anterior (PA) (a), lateral (b), left bend (c), and right bend (d) radiographs demonstrate a 57° main thoracic curve. First-erect post-operative PA (e) and lateral (f), and 5-year post-operative PA (g) and lateral (h) radiographs demonstrate correction of the coronal plane deformity down to 15° with a T5–T12 posterior instrumented spinal fusion. The patient was fused to one level short of the stable vertebra. The deformity then progressed to 41° at final follow-up. At the most recent follow-up, the patient has developed a 16° thoracic rib prominence with worsening trunk shift to the right and waist asymmetry
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Fig1: A 12 years and 8 months old, Risser grade 0, pre-menarchal female with Lenke type 1B idiopathic scoliosis. Pre-operative posterior-anterior (PA) (a), lateral (b), left bend (c), and right bend (d) radiographs demonstrate a 57° main thoracic curve. First-erect post-operative PA (e) and lateral (f), and 5-year post-operative PA (g) and lateral (h) radiographs demonstrate correction of the coronal plane deformity down to 15° with a T5–T12 posterior instrumented spinal fusion. The patient was fused to one level short of the stable vertebra. The deformity then progressed to 41° at final follow-up. At the most recent follow-up, the patient has developed a 16° thoracic rib prominence with worsening trunk shift to the right and waist asymmetry

Mentions: Seventy-six patients (86 %) were in the stable control group and 13 patients (14 %) were found to experience deformity progression of more than 10° in the coronal plane within 2 years of surgery (Fig. 1). The stable group comprised 14 boys and 62 girls, and the deformity progression group comprised three boys and ten girls. The average follow-up for this cohort was 4.2 years (range 2.0–8.3 years).Fig. 1


Spinal deformity progression after posterior segmental instrumentation and fusion for idiopathic scoliosis.

Upasani VV, Hedequist DJ, Hresko MT, Karlin LI, Emans JB, Glotzbecker MP - J Child Orthop (2015)

A 12 years and 8 months old, Risser grade 0, pre-menarchal female with Lenke type 1B idiopathic scoliosis. Pre-operative posterior-anterior (PA) (a), lateral (b), left bend (c), and right bend (d) radiographs demonstrate a 57° main thoracic curve. First-erect post-operative PA (e) and lateral (f), and 5-year post-operative PA (g) and lateral (h) radiographs demonstrate correction of the coronal plane deformity down to 15° with a T5–T12 posterior instrumented spinal fusion. The patient was fused to one level short of the stable vertebra. The deformity then progressed to 41° at final follow-up. At the most recent follow-up, the patient has developed a 16° thoracic rib prominence with worsening trunk shift to the right and waist asymmetry
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4340851&req=5

Fig1: A 12 years and 8 months old, Risser grade 0, pre-menarchal female with Lenke type 1B idiopathic scoliosis. Pre-operative posterior-anterior (PA) (a), lateral (b), left bend (c), and right bend (d) radiographs demonstrate a 57° main thoracic curve. First-erect post-operative PA (e) and lateral (f), and 5-year post-operative PA (g) and lateral (h) radiographs demonstrate correction of the coronal plane deformity down to 15° with a T5–T12 posterior instrumented spinal fusion. The patient was fused to one level short of the stable vertebra. The deformity then progressed to 41° at final follow-up. At the most recent follow-up, the patient has developed a 16° thoracic rib prominence with worsening trunk shift to the right and waist asymmetry
Mentions: Seventy-six patients (86 %) were in the stable control group and 13 patients (14 %) were found to experience deformity progression of more than 10° in the coronal plane within 2 years of surgery (Fig. 1). The stable group comprised 14 boys and 62 girls, and the deformity progression group comprised three boys and ten girls. The average follow-up for this cohort was 4.2 years (range 2.0–8.3 years).Fig. 1

Bottom Line: At 2-years post-op, the patients in the deformity progression group had experienced a significantly greater change in upper instrumented vertebra (UIV) angulation, lower instrumented vertebra (LIV) angulation, and apical vertebral translation (AVT).Patients in the deformity progression group had a significantly greater difference between the lowest instrumented vertebra and stable vertebra compared to patients in the stable group (p = 0.001).Level III.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA, USA, vupasani@rchsd.org.

ABSTRACT

Study design: Retrospective chart and radiographic review.

Purpose: To assess the incidence of and variables associated with spinal deformity progression after posterior segmental instrumentation and fusion at a single institution. Progression of the scoliotic deformity after posterior instrumented spinal fusion has been described. Recent studies have concluded that segmental pedicle screw constructs are better able to control deformity progression.

Methods: Retrospective review of a consecutive series of idiopathic scoliosis patients (n = 89) with major thoracic curves (Lenke types 1-4) treated with posterior segmental instrumentation and fusion. Deformity progression was defined as a 10° increase in Cobb angle between the first-erect and 2-year post-operative radiographs. Clinical and radiographic data between the two cohorts (deformity progression versus stable) were analyzed to determine the variables associated with deformity progression.

Results: Patients in the deformity progression group (n = 13) tended to be younger (median 13.7 vs. 14.7 years) and experienced a significant change in height (p = 0.01) during the post-operative period compared to the stable group (n = 76). At 2-years post-op, the patients in the deformity progression group had experienced a significantly greater change in upper instrumented vertebra (UIV) angulation, lower instrumented vertebra (LIV) angulation, and apical vertebral translation (AVT). Two-year post-op Scoliosis Research Society questionnaire (SRS-22) scores in the appearance domain were also significantly worse in the deformity progression group. Patients in the deformity progression group had a significantly greater difference between the lowest instrumented vertebra and stable vertebra compared to patients in the stable group (p = 0.001).

Conclusions: Deformity progression after posterior spinal fusion does occur after modern segmental instrumentation. Segmental pedicle screw constructs do not prevent deformity progression. Skeletally immature patients with a significant growth potential are at the highest risk for deformity progression. In immature patients, extending the fusion distally to the stable vertebra may minimize deformity progression.

Level of evidence: Level III.

No MeSH data available.


Related in: MedlinePlus