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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 thoracolumbar/lumbar (blue) and compensatory thoracic (red) Cobb angle preoperatively, immediately postoperatively and 1 and 2 years after selective thoracolumbar/lumbar instrumented spinal fusion surgery
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Fig5: Main thoracolumbar/lumbar (blue) and compensatory thoracic (red) Cobb angle preoperatively, immediately postoperatively and 1 and 2 years after selective thoracolumbar/lumbar instrumented spinal fusion surgery

Mentions: Our results are consistent with previous reports in the literature [2, 18–20], with 25 % of our patients demonstrating adding-on with a relevant progression/extension (>5°) of the instrumented major curve after performing a selective thoracic fusion. Of all recorded parameters, only the LSTOA could be identified as a possible risk factor for our patients to sustain adding-on. A greater LSTOA was significantly associated with a greater preoperative compensatory TL/L curve magnitude (Fig. 5). This, conversely, resulted in a lower average correction of the compensatory TL/L curve of 53 % in patients with adding-on, compared to a mean decrease in Cobb angle of 64 % in those patients without adding-on. Abel et al. [3] in 2011 looked at 204 patients with idiopathic scoliosis who had undergone posterior spinal arthrodesis. They compared selective versus non-selective thoracic spinal fusion and demonstrated that both groups showed a positive correlation between preoperative LSTOA and preoperative TL/L Cobb angle, and both groups significantly improved in coronal TL/L Cobb angle as well as in LSTOA postoperatively. Interestingly, in the non-selective fusion group the LSTOA decreased by an average of 11° compared to only 2° in the selective fusion group. They concluded that to appreciably change the LSTOA with a posterior spinal fusion the distal level of fixation must be beyond the apex of the TL/L curve. This again adds further controversy to the discussion of whether a stiffer straight spine leads to a better outcome than a less straight but more mobile spine.Fig. 5


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

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

Fig5: Main thoracolumbar/lumbar (blue) and compensatory thoracic (red) Cobb angle preoperatively, immediately postoperatively and 1 and 2 years after selective thoracolumbar/lumbar instrumented spinal fusion surgery
Mentions: Our results are consistent with previous reports in the literature [2, 18–20], with 25 % of our patients demonstrating adding-on with a relevant progression/extension (>5°) of the instrumented major curve after performing a selective thoracic fusion. Of all recorded parameters, only the LSTOA could be identified as a possible risk factor for our patients to sustain adding-on. A greater LSTOA was significantly associated with a greater preoperative compensatory TL/L curve magnitude (Fig. 5). This, conversely, resulted in a lower average correction of the compensatory TL/L curve of 53 % in patients with adding-on, compared to a mean decrease in Cobb angle of 64 % in those patients without adding-on. Abel et al. [3] in 2011 looked at 204 patients with idiopathic scoliosis who had undergone posterior spinal arthrodesis. They compared selective versus non-selective thoracic spinal fusion and demonstrated that both groups showed a positive correlation between preoperative LSTOA and preoperative TL/L Cobb angle, and both groups significantly improved in coronal TL/L Cobb angle as well as in LSTOA postoperatively. Interestingly, in the non-selective fusion group the LSTOA decreased by an average of 11° compared to only 2° in the selective fusion group. They concluded that to appreciably change the LSTOA with a posterior spinal fusion the distal level of fixation must be beyond the apex of the TL/L curve. This again adds further controversy to the discussion of whether a stiffer straight spine leads to a better outcome than a less straight but more mobile spine.Fig. 5

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