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

Main thoracic (blue) and compensatory thoracolumbar/lumbar (red) Cobb angle preoperatively, immediately postoperatively and 1 and 2 years after selective thoracic instrumented spinal fusion surgery
© Copyright Policy - OpenAccess
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4417731&req=5

Fig3: Main thoracic (blue) and compensatory thoracolumbar/lumbar (red) Cobb angle preoperatively, immediately postoperatively and 1 and 2 years after selective thoracic instrumented spinal fusion surgery

Mentions: Mean age at the time of surgery was 14.7 years (range 11.3–18.5). Examination of skeletal maturity based on the Risser sign revealed that 50 % of patients had a score of 4 or 5 [0 (n = 1), 1 (n = 2), 2 (n = 2), 3 (n = 3), 4 (n = 7), 5 (n = 1)]. Curve types according to the Lenke classification were: 1B (n = 4), 1C (n = 9), 2B (n = 2), 3C (n = 1). Mean preoperative MT Cobb angle was 63° (range 52°–81°), corrected to an average of 20° immediately postoperatively, and to 24° at 2-year follow-up. Mean compensatory TL/L Cobb angle was 42° (range 30°–54°), decreasing to an average of 18° immediately postoperatively, remaining the same at the 2-year follow-up (Fig. 3).Fig. 3


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)

Main thoracic (blue) and compensatory thoracolumbar/lumbar (red) Cobb angle preoperatively, immediately postoperatively and 1 and 2 years after selective thoracic instrumented spinal fusion surgery
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig3: Main thoracic (blue) and compensatory thoracolumbar/lumbar (red) Cobb angle preoperatively, immediately postoperatively and 1 and 2 years after selective thoracic instrumented spinal fusion surgery
Mentions: Mean age at the time of surgery was 14.7 years (range 11.3–18.5). Examination of skeletal maturity based on the Risser sign revealed that 50 % of patients had a score of 4 or 5 [0 (n = 1), 1 (n = 2), 2 (n = 2), 3 (n = 3), 4 (n = 7), 5 (n = 1)]. Curve types according to the Lenke classification were: 1B (n = 4), 1C (n = 9), 2B (n = 2), 3C (n = 1). Mean preoperative MT Cobb angle was 63° (range 52°–81°), corrected to an average of 20° immediately postoperatively, and to 24° at 2-year follow-up. Mean compensatory TL/L Cobb angle was 42° (range 30°–54°), decreasing to an average of 18° immediately postoperatively, remaining the same at the 2-year follow-up (Fig. 3).Fig. 3

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