Limits...
Selective fusion in adolescent idiopathic scoliosis: a radiographic evaluation of risk factors for imbalance.

Studer D, Awais A, Williams N, Antoniou G, Eardley-Harris N, Cundy P - J Child Orthop (2015)

Bottom Line: In group B, global coronal balance was identified as a significant risk factor for adding-on.Patients with adding-on had significantly higher coronal balance scores (mean 3.6) than those who did not experience adding-on (mean 1.9) (p = 0.03).In addition, those with adding-on had a significantly smaller bending lumbar Cobb angle (mean 15) than those without adding-on (mean 31.6) (p = 0.015).

View Article: PubMed Central - PubMed

Affiliation: Orthopaedic Department, University Children's Hospital, PO Box 4031, Basel, Switzerland, daniel.studer@ukbb.ch.

ABSTRACT

Study design: Retrospective database, chart and medical imaging review.

Objectives: To report on the outcome and evaluate possible risk factors for postoperative complications following selective spinal fusion in patients with adolescent idiopathic scoliosis (AIS).

Materials and methods: All patients with AIS who underwent either a selective thoracic or selective thoracolumbar/lumbar spinal fusion at our institution from January 2001 to December 2011 inclusive were included in this study. The minimum postoperative follow-up period of all patients was 2 years.

Results: During the 11-year study period, 157 patients with AIS underwent surgery for their progressive spinal deformity. Thirty patients (19 %) had a selective spinal fusion, with 16 patients (group A) having a selective thoracic, and 14 patients (group B) having a selective thoracolumbar/lumbar spinal arthrodesis. In both groups the main postoperative complications were adding-on (25 % group A, 36 % group B) and coronal decompensation (25 % group A, 29 % group B). In group A, no statistically significant risk factors for postoperative complications were identified. In group B, global coronal balance was identified as a significant risk factor for adding-on. Patients with adding-on had significantly higher coronal balance scores (mean 3.6) than those who did not experience adding-on (mean 1.9) (p = 0.03). In addition, those with adding-on had a significantly smaller bending lumbar Cobb angle (mean 15) than those without adding-on (mean 31.6) (p = 0.015). None of the patients who underwent selective spinal fusion required revision surgery.

Conclusion: Although the complication rate after performing a selective spinal fusion is high, the revision rate remains low and the debate whether or not to perform a selective spinal fusion will continue.

No MeSH data available.


Related in: MedlinePlus

Female patient with adolescent idiopathic scoliosis Lenke type 1CN before (a) and after (b) selective thoracic posterior instrumented spinal fusion
© Copyright Policy - OpenAccess
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4417731&req=5

Fig1: Female patient with adolescent idiopathic scoliosis Lenke type 1CN before (a) and after (b) selective thoracic posterior instrumented spinal fusion

Mentions: A selective thoracic fusion was defined as a fusion in which only the thoracic curve(s) was instrumented and distal fixation terminated at or above the first lumbar vertebra (L1) in patients with lumbar modifier B or C [21]. A selective thoracolumbar/lumbar fusion was defined as a fusion in which only the thoracolumbar/lumbar curve was instrumented and proximal fixation terminated at or below the ninth thoracic vertebra (T9) [21]. In group (A) patients with lumbar modifier A, and in both groups any patients with prior spinal surgery, were excluded. All selective thoracic spinal fusions were performed via a posterior approach using hybrid constructs with pedicle screws and hooks for instrumentation (Fig. 1). All patients having a selective thoracolumbar/lumbar spinal fusion underwent an anterior instrumentation with double rod screw fixation (Fig. 2).Fig. 1


Selective fusion in adolescent idiopathic scoliosis: a radiographic evaluation of risk factors for imbalance.

Studer D, Awais A, Williams N, Antoniou G, Eardley-Harris N, Cundy P - J Child Orthop (2015)

Female patient with adolescent idiopathic scoliosis Lenke type 1CN before (a) and after (b) selective thoracic posterior instrumented spinal fusion
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4417731&req=5

Fig1: Female patient with adolescent idiopathic scoliosis Lenke type 1CN before (a) and after (b) selective thoracic posterior instrumented spinal fusion
Mentions: A selective thoracic fusion was defined as a fusion in which only the thoracic curve(s) was instrumented and distal fixation terminated at or above the first lumbar vertebra (L1) in patients with lumbar modifier B or C [21]. A selective thoracolumbar/lumbar fusion was defined as a fusion in which only the thoracolumbar/lumbar curve was instrumented and proximal fixation terminated at or below the ninth thoracic vertebra (T9) [21]. In group (A) patients with lumbar modifier A, and in both groups any patients with prior spinal surgery, were excluded. All selective thoracic spinal fusions were performed via a posterior approach using hybrid constructs with pedicle screws and hooks for instrumentation (Fig. 1). All patients having a selective thoracolumbar/lumbar spinal fusion underwent an anterior instrumentation with double rod screw fixation (Fig. 2).Fig. 1

Bottom Line: In group B, global coronal balance was identified as a significant risk factor for adding-on.Patients with adding-on had significantly higher coronal balance scores (mean 3.6) than those who did not experience adding-on (mean 1.9) (p = 0.03).In addition, those with adding-on had a significantly smaller bending lumbar Cobb angle (mean 15) than those without adding-on (mean 31.6) (p = 0.015).

View Article: PubMed Central - PubMed

Affiliation: Orthopaedic Department, University Children's Hospital, PO Box 4031, Basel, Switzerland, daniel.studer@ukbb.ch.

ABSTRACT

Study design: Retrospective database, chart and medical imaging review.

Objectives: To report on the outcome and evaluate possible risk factors for postoperative complications following selective spinal fusion in patients with adolescent idiopathic scoliosis (AIS).

Materials and methods: All patients with AIS who underwent either a selective thoracic or selective thoracolumbar/lumbar spinal fusion at our institution from January 2001 to December 2011 inclusive were included in this study. The minimum postoperative follow-up period of all patients was 2 years.

Results: During the 11-year study period, 157 patients with AIS underwent surgery for their progressive spinal deformity. Thirty patients (19 %) had a selective spinal fusion, with 16 patients (group A) having a selective thoracic, and 14 patients (group B) having a selective thoracolumbar/lumbar spinal arthrodesis. In both groups the main postoperative complications were adding-on (25 % group A, 36 % group B) and coronal decompensation (25 % group A, 29 % group B). In group A, no statistically significant risk factors for postoperative complications were identified. In group B, global coronal balance was identified as a significant risk factor for adding-on. Patients with adding-on had significantly higher coronal balance scores (mean 3.6) than those who did not experience adding-on (mean 1.9) (p = 0.03). In addition, those with adding-on had a significantly smaller bending lumbar Cobb angle (mean 15) than those without adding-on (mean 31.6) (p = 0.015). None of the patients who underwent selective spinal fusion required revision surgery.

Conclusion: Although the complication rate after performing a selective spinal fusion is high, the revision rate remains low and the debate whether or not to perform a selective spinal fusion will continue.

No MeSH data available.


Related in: MedlinePlus