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Sato K, Kotani T, Sakuma T, Iijima Y, Asada T, Akazawa T, Minami S, Ohtori S, Koda M, Yamazaki M. Prevalence of pleural injury in an extrapleural approach to adolescent idiopathic scoliosis and association of pleural injury with postoperative respiratory function. J Orthop Sci 2024; 29:71-77. [PMID: 36460556 DOI: 10.1016/j.jos.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 10/01/2022] [Accepted: 11/06/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND The prevalence of pleural injury during surgery for adolescent idiopathic scoliosis using an extrapleural approach and the association of pleural injury with postoperative pulmonary function remain unclear. We sought to determine the prevalence of pleural injury associated with an extrapleural approach to adolescent idiopathic scoliosis, and to determine any difference in respiratory function between patients with or without pleural injury. METHODS Data from consecutive patients with scoliosis of the thoracolumbar/lumbar spine who underwent anterior spinal fusion using an extrapleural approach were assessed in this retrospective study. We had diagnosed and treated pleural injury according to our algorithm. Pre- and postoperative values of pulmonary function tests and postoperative change rates were compared between patients with and without pleural injury. FVC, %FVC, FEV1.0, and FEV1.0% were evaluated from pulmonary function tests. RESULTS We included data from 51 patients with adolescent idiopathic scoliosis (45 female and 6 male) with a mean age of 17.2 ± 3.5 years in this retrospective study. The group with pleural injury comprised 31 patients and the group without 20. Therefore, the prevalence of pleural injury during an extrapleural approach was 61%. We found no significant differences in preoperative FVC, %FVC, FEV1.0, and FEV1.0% between the groups. We found no significant differences in FVC, %FVC, FEV1.0, and FEV1.0% between the groups at 3 months or 1 year postoperatively. Furthermore, we found no significant differences in the postoperative change ratio of FVC, %FVC, FEV1.0, and FEV1.0% between the groups. CONCLUSION The prevalence of pleural injury associated with an extrapleural approach to scoliosis was 61%. Pleural injury was not associated with a decrease in postoperative pulmonary function in patients with scoliosis treated using an extrapleural approach.
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Affiliation(s)
- Kosuke Sato
- Seirei Sakura Citizen Hospital, Department of Orthopedic Surgery, Sakura, Japan; University of Tsukuba, Faculty of Medicine, Department of Orthopaedic Surgery, Tsukuba, Japan.
| | - Toshiaki Kotani
- Seirei Sakura Citizen Hospital, Department of Orthopedic Surgery, Sakura, Japan
| | - Tsuyoshi Sakuma
- Seirei Sakura Citizen Hospital, Department of Orthopedic Surgery, Sakura, Japan
| | - Yasushi Iijima
- Seirei Sakura Citizen Hospital, Department of Orthopedic Surgery, Sakura, Japan
| | - Tomoyuki Asada
- University of Tsukuba, Faculty of Medicine, Department of Orthopaedic Surgery, Tsukuba, Japan
| | - Tsutomu Akazawa
- St. Marianna University, School of Medicine, Department of Orthopaedic Surgery, Kawasaki, Kanagawa, Japan
| | - Shohei Minami
- Seirei Sakura Citizen Hospital, Department of Orthopedic Surgery, Sakura, Japan
| | - Seiji Ohtori
- Chiba University, Graduate School of Medicine, Department of Orthopedics Surgery, Chiba, Japan
| | - Masao Koda
- University of Tsukuba, Faculty of Medicine, Department of Orthopaedic Surgery, Tsukuba, Japan
| | - Masashi Yamazaki
- University of Tsukuba, Faculty of Medicine, Department of Orthopaedic Surgery, Tsukuba, Japan
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Anterior versus posterior spinal fusion for Lenke type 5 adolescent idiopathic scoliosis: a systematic review and meta-analysis of comparative studies. Spine Deform 2022; 10:267-281. [PMID: 34725791 DOI: 10.1007/s43390-021-00436-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 10/23/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To review and compare clinical and radiologic outcomes between anterior spinal fusion (ASF) and posterior spinal fusion (PSF) for the treatment of Lenke type 5 adolescent idiopathic scoliosis (AIS). METHODS A systematic review was performed according to Preferred reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. All level I-III evidence studies investigating the clinical and radiologic outcomes of ASF and PSF for the treatment of Lenke type 5 AIS were included. RESULTS Nine studies (285 ASF patients, 298 PSF patients) were included. ASF was associated with a significantly lower number of levels fused compared with PSF (p < 0.01) with similar immediate and long-term coronal deformity correction (p = 0.16; p = 0.12, respectively). PSF achieved a better correction of thoracic hypokyphosis in one study and lumbar hypolordosis in three studies. PSF was associated with a significant shorter length of stay (LOS) compared with ASF (p < 0.01). One long-term study demonstrated a significantly higher rate of proximal junctional kyphosis (PJK) with PSF compared with ASF. There were no significant differences in major complication or re-operation rates. CONCLUSION For the treatment of Lenke type 5 AIS, there is moderate evidence to suggest that ASF requires a lower number of instrumented levels to achieve similar immediate and long-term coronal deformity correction compared with PSF. There is some evidence to suggest that PSF may achieve better thoracic and lumbar sagittal deformity correction compared with ASF. There is some evidence to suggest a higher incidence of PJK at long-term follow-up with PSF compared with ASF. ASF is associated with a longer post-operative LOS compared with PSF.
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Farshad M, Frey A, Jentzsch T, Betz M, Widmer J, Spirig JM. Reducing the kyphosis effect of anterior short thoracolumbar/lumbar scoliosis correction with an autograft fulcrum effect. BMC Musculoskelet Disord 2021; 22:216. [PMID: 33622298 PMCID: PMC7903709 DOI: 10.1186/s12891-021-04083-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 02/09/2021] [Indexed: 11/15/2022] Open
Abstract
Background Anterior scoliosis correction is a powerful technique with the disadvantage of a kyphotic effect on lumbar and thoracolumbar curves. We aimed to investigate whether a cognizant interposition of a rib graft anteriorly and at the concave side of the scoliotic curve causes significant fulcrum effect to enforce scoliosis correction and to reduce interfusional kyphosis in anterior scoliosis corrections. Methods Twenty otherwise comparable patients with lumbar and thoracolumbar adolescent idiopathic scoliosis (AIS) curves undergoing anterior short scoliosis correction with (n = 10) or without (n = 10, matched for age, gender and degree of deformity) fulcrum effect were retrospectively compared by means of radiographic measurements (sagittal and coronal profile, Cobb angles and intersegmental deformity correction angles) to evaluate the effect of this modified surgical technique. Results The overall amount of scoliosis correction was similar with 74 and 60% of initial curves of 57° and 53° in the case and control group respectively with a mean of 3 fused segments (4 screws). Statistically relevant differences were found for intersegmental coronal cobb angles at the apex of 20° to 3° and 17° to 9° with and without fulcrum, respectively (p < 0.05). Creation of kyphosis in the fused segments was reduced with an interfusional kyphotic sagittal cobb angle of 15° pre-operatively vs. 3° post-operatively compared to the control group (13° pre-operatively vs. 18° post-operatively), (p < 0.05). Conclusions Interfusional hyperkyphosis associated with anterior scoliosis correction for thoracolumbar/lumbar curves can be reduced with cognizant positioning of the bone autograft at the antero-lateral (concave) site in the intervertebral region to create a fulcrum effect. Trial registration Registered at swissethics: BASEC No.: 2018–00180.
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Affiliation(s)
- Mazda Farshad
- Spine Division, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Andrea Frey
- Spine Division, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Thorsten Jentzsch
- Spine Division, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Michael Betz
- Spine Division, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Jonas Widmer
- Laboratory for Orthopaedic Biomechanics, Balgrist University Hospital, Zürich, Switzerland.,Institute of Biomechanics, ETH Zurich, Zurich, Switzerland
| | - José Miguel Spirig
- Spine Division, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
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Conformity and Changes in the Radiological Neck and Shoulder Balance Parameters Throughout 3-Year Follow-up Period: Do They Remain the Same? Spine (Phila Pa 1976) 2020; 45:E319-E328. [PMID: 31593064 DOI: 10.1097/brs.0000000000003275] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE The primary objective of this study was to assess the conformity of the radiological neck and shoulder balance parameters throughout a follow-up period of more than 2 years. SUMMARY OF BACKGROUND DATA Postoperative shoulder and neck imbalance are undesirable features among Adolescent Idiopathic Scoliosis patients who underwent Posterior Spinal Fusion. There are many clinical and radiological parameters used to assess this clinical outcome. However, we do not know whether these radiological parameters conform throughout the entire follow-up period. METHODS This was a retrospective study done in a single academic institution. Inclusion criteria were patients with scoliosis who underwent posterior instrumented spinal fusion with pedicle screw fixation and attended all scheduled follow-ups for at least 24 months postoperatively. Radiological shoulder parameters were measured from both preoperative antero-posterior and postoperative antero-posterior radiographs. Lateral shoulder parameters were: Radiographic Shoulder Height, Clavicle Angle (Cla-A), Clavicle-Rib Intersection Difference, and Coracoid Height Difference. Medial shoulder and neck parameters were: T1 Tilt and Cervical Axis (CA). RESULTS The radiographs of 50 patients who had surgery done from November 2013 to November 2015 were analyzed. Mean age of this cohort was 16.3 ± 7.0 years. There were 38 (76%) female patients and 12 (24%) male patients. Mean final follow-up was 38.6 ± 5.8 months. When conformity assessment of the radiological parameter using the interclass coefficient correlation was done, we found that all parameters had significant correlation (P < 0.05). T1 tilt (0.78) had good reliability, CA (0.47), Clavicle-Rib Intersection Difference (0.43), and Coracoid Height Difference (0.40) had moderate reliability and Radiographic Shoulder Height (0.22) and Cla-A (0.13) had poor reliability. CONCLUSION All the radiological shoulder and neck balance parameters studied were conformed and suitable to be used to assess the patient postoperatively. Amongst these radiological parameters, T1 tilt followed by CA recorded to be the most reliable parameters over time. LEVEL OF EVIDENCE 4.
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Min K, Jud L, Farshad M. Dual Sequential Short Anterior Correction in Double Major Adolescent Idiopathic Scoliosis. Spine Deform 2019; 6:545-551. [PMID: 30122390 DOI: 10.1016/j.jspd.2018.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 01/09/2018] [Accepted: 01/14/2018] [Indexed: 10/28/2022]
Abstract
STUDY DESIGN retrospective comparative study. INTRODUCTION The standard surgical technique for double major adolescent idiopathic scoliosis (AIS) has been the fusion of both thoracic and thoracolumbar/lumbar curves from the posterior approach. Although short anterior correction is established in AIS with single thoracic or thoracolumbar/lumbar curves, anterior correction in double major curves has not yet been described. The purpose of this study is to compare this novel technique with standard posterior pedicle screw instrumentation in double major AIS. METHODS 19 consecutive patients with a double major AIS were treated surgically either with pedicle screw instrumentation and posterior fusion (n = 11) or dual anterior short instrumentation and fusion (n = 8) of both curves. The mean follow-up was 5.6 ± 3 years (2-10 years). Clinical and radiologic results, results of pulmonary function, and Scoliosis Research Society (SRS) questionnaire are analyzed and compared. RESULTS The length of fusion was 7.6 ± 0.7 vertebrae with the anterior technique and 12 ± 1 vertebrae with the posterior technique (p < .001). Cobb angle correction was 78% and 53% in thoracic curves, and 80% and 59% in lumbar curves with posterior and anterior technique respectively (p < .05). The preoperative pulmonary function remained unchanged to the last follow-up in both groups. The scores of SRS-24 questionnaire were similar preoperatively and at the last follow-up in both groups. CONCLUSION This novel technique of dual sequential short anterior correction is an alternative to the standard posterior long fusions in the double major AIS. A significantly less amount of mobile segments needs to be fused leaving the thoracolumbar junction mobile and saving at least one lumbar mobile segment distally. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Kan Min
- Departement of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland.
| | - Lukas Jud
- Departement of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Mazda Farshad
- Departement of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland
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Hu B, Yang X, Lyu Q, Wang L, Liu L, Zhu C, Zhou C, Song Y. Comparison of Extending Fusion to Thoracic Curve Versus Thoracolumbar/Lumbar Fusion in Posterior Fusion of Patients with Lenke 5C: Variation in Upper End Vertebrae Tilt Affected Coronal Balance. World Neurosurg 2018; 121:e827-e835. [PMID: 30312815 DOI: 10.1016/j.wneu.2018.09.232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 09/28/2018] [Accepted: 09/28/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Extended fusion can be performed in patients with Lenke 5C adolescent idiopathic scoliosis (AIS) with a large and relatively rigid thoracic curve. Progression of the thoracic curve is related to coronal imbalance. We aimed to determine the correlation between the upper instrumented vertebra choice and coronal balance in patients with Lenke 5C AIS. METHODS A total of 61 patients with Lenke 5C AIS underwent posterior fusion from 2009 to 2015 in a single institution with ≥2 years of follow-up data available. The extended fusion group (n = 32) and thoracolumbar/lumbar (TL/L) fusion group (n = 29) were compared for the correction rates for the main TL/L and thoracic curves, coronal balance, upper end vertebra (UEV) tilt, and Scoliosis Research Society-22 questionnaire score. RESULTS Both groups had excellent correction of the main TL/L curve, and the extended fusion group had a significantly greater correction rate of the thoracic curve than the TL/L fusion group (70.2% vs. 57.3%). The incidence of coronal imbalance was similar in both groups. The spontaneous change in UEV tilt was associated with the change in coronal balance from the first to the final follow-up examination. In the TL/L fusion group, the increase in UEV tilt from the first to final follow-up visit resulted in improved coronal balance at the final follow-up examination. Both groups had similar Scoliosis Research Society-22 questionnaire scores at 2 years postoperatively. CONCLUSIONS In patients with Lenke 5C AIS, thoracic curve fusion results in better correction of the thoracic curve but no improvement in coronal balance. With TL/L fusion, a postoperative UEV tilt >5° leads to better coronal balance.
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Affiliation(s)
- Bowen Hu
- Department of Orthopedics Surgery, West China Hospital, Sichuan University, Sichuan, China
| | - Xi Yang
- Department of Orthopedics Surgery, West China Hospital, Sichuan University, Sichuan, China
| | - Qiunan Lyu
- Department of Orthopedics Surgery, West China Hospital, Sichuan University, Sichuan, China
| | - Linnan Wang
- Department of Orthopedics Surgery, West China Hospital, Sichuan University, Sichuan, China
| | - Limin Liu
- Department of Orthopedics Surgery, West China Hospital, Sichuan University, Sichuan, China
| | - Ce Zhu
- Department of Orthopedics Surgery, West China Hospital, Sichuan University, Sichuan, China
| | - Chunguang Zhou
- Department of Orthopedics Surgery, West China Hospital, Sichuan University, Sichuan, China
| | - Yueming Song
- Department of Orthopedics Surgery, West China Hospital, Sichuan University, Sichuan, China.
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Lin Y, Chen W, Chen A, Li F, Xiong W. Anterior versus Posterior Selective Fusion in Treating Adolescent Idiopathic Scoliosis: A Systematic Review and Meta-Analysis of Radiologic Parameters. World Neurosurg 2018; 111:e830-e844. [DOI: 10.1016/j.wneu.2017.12.161] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 12/24/2017] [Accepted: 12/27/2017] [Indexed: 10/18/2022]
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Prognostic Role of Rib Hump in Overlying Thoracic Curve Correction Above Selective Fusion for Lenke 5 Idiopathic Adolescent Scoliosis. Clin Spine Surg 2018; 31:E140-E145. [PMID: 29088010 DOI: 10.1097/bsd.0000000000000590] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN Prospective study. OBJECTIVE To assess whether rib hump is a prognostic factor of final thoracic Cobb angle. SUMMARY OF BACKGROUND DATA Correction of thoracolumbar/lumbar curve, preoperative thoracic curves angle, thoracic curves angle on bending, the thoracolumbar-lumbar angle/thoracic curves angle ratio, thoracic kyphosis, and growth stage influences spontaneous correction of uninstrumented thoracic curves angle above selective fusion for Lenke 5 Adolescent Idiopathic Scoliosis. Indeed, preoperative rib hump has never been expressly evaluated as a prognostic factor of final thoracic curves angle. METHODS In total, 50 patients with Lenke 5 Adolescent Idiopathic Scoliosis, selectively instrumented with posterior construct were included. Two patients were lost to follow-up and 48 had follow-up ≥2 years. Demographic data, preoperative thoracic rib hump (measured in millimeter in trunk anteflexion), and radiologic spinal parameters were recorded preoperatively and at last consultation. T test was used to compare mean values, linear and logistic regressions to assess predictability of final thoracic curve angle. RESULTS Main thoracolumbar-lumbar curve angle decreased from 47 degrees (range, 36-72 degrees) to 12 degrees at the final consultation (range, 1-28 degrees). Thoracic curves angle decreased from 26 degrees (range, 2-40 degrees) preoperatively to 16 degrees (range, 2-41 degrees) at the final consultation (P=0.001) (correction=37%). Preoperative rib hump was present in 10 patients. Final thoracic Cobb angle was 27 degrees (8-41 degrees) in patients with rib hump and 14 degrees (0-32 degrees) in patients without rib hump (P<0.001).Multiregression highlighted thoracic curves angle on bending (P=0.001), preoperative thoracic curves angle (P=0.011) and rib hump (P=0.012) as prognostic factors of higher final thoracic curves angle. CONCLUSION Rib hump significantly influenced final thoracic curves angle. LEVEL OF EVIDENCE Level III-prospective study.
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Zhang S, Zhang L, Feng X, Yang H. Incidence and risk factors for postoperative shoulder imbalance in scoliosis: a systematic review and meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 27:358-369. [DOI: 10.1007/s00586-017-5289-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/20/2017] [Accepted: 08/27/2017] [Indexed: 01/11/2023]
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Zhang Y, Lin G, Wang S, Zhang J, Shen J, Wang Y, Guo J, Yang X, Zhao L. Higher Flexibility and Better Immediate Spontaneous Correction May Not Gain Better Results for Nonstructural Thoracic Curve in Lenke 5C AIS Patients: Risk Factors for Its Correction Loss. Spine (Phila Pa 1976) 2016; 41:1731-1739. [PMID: 27831989 PMCID: PMC5113247 DOI: 10.1097/brs.0000000000001760] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 06/12/2016] [Accepted: 06/16/2016] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE To study the behavior of the unfused thoracic curve in Lenke type 5C during the follow-up and to identify risk factors for its correction loss. SUMMARY OF BACKGROUND DATA Few studies have focused on the spontaneous behaviors of the unfused thoracic curve after selective thoracolumbar or lumbar fusion during the follow-up and the risk factors for spontaneous correction loss. METHODS We retrospectively reviewed 45 patients (41 females and 4 males) with AIS who underwent selective TL/L fusion from 2006 to 2012 in a single institution. The follow-up averaged 36 months (range, 24-105 months). Patients were divided into two groups. Thoracic curves in group A improved or maintained their curve magnitude after spontaneous correction, with a negative or no correction loss during the follow-up. Thoracic curves in group B deteriorated after spontaneous correction with a positive correction loss. Univariate analysis and multivariate analysis were built to identify the risk factors for correction loss of the unfused thoracic curves. RESULTS The minor thoracic curve was 26° preoperatively. It was corrected to 13° immediately with a spontaneous correction of 48.5%. At final follow-up it was 14° with a correction loss of 1°. Thoracic curves did not deteriorate after spontaneous correction in 23 cases in group A, while 22 cases were identified with thoracic curve progressing in group B. In multivariate analysis, two risk factors were independently associated with thoracic correction loss: higher flexibility and better immediate spontaneous correction rate of thoracic curve. CONCLUSION Posterior selective TL/L fusion with pedicle screw constructs is an effective treatment for Lenke 5C AIS patients. Nonstructural thoracic curves with higher flexibility or better immediate correction are more likely to progress during the follow-up and close attentions must be paid to these patients in case of decompensation. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Yanbin Zhang
- Department of Orthopedics, Peking Union Medical College Hospital, Beijing, P.R. China
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Abel MF, Singla A, Feger MA, Sauer LD, Novicoff W. Surgical treatment of Lenke 5 adolescent idiopathic scoliosis: Comparison of anterior vs posterior approach. World J Orthop 2016; 7:553-560. [PMID: 27672568 PMCID: PMC5027010 DOI: 10.5312/wjo.v7.i9.553] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 06/01/2016] [Accepted: 08/01/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To compare the posterior vs anterior approaches for fusion of Lenke 5 adolescent idiopathic scoliosis curves, matched for curve magnitude and for the distal level of fixation (dLOF) standardized to the third lumbar vertebrae (L3).
METHODS A prospectively collected multicenter database was used for this retrospective comparative study. Our dependent variables included sagittal and coronal radiographic measurements, number of fused vertebrae, estimated blood loss, length of hospitalization and SRS total and individual domain scores at the two-year follow-up. Subject demographics were similar for all group comparisons. Independent t-test was used to compare groups for all analyses at P < 0.01.
RESULTS For all matched cases of Lenke 5 curves, a selective approach was used only 50% of the time in cases undergoing a posterior fusion. When comparing a posterior selective approach to an anterior selective approach, surgeons utilizing a posterior approach fused significantly more levels than surgeons using an anterior approach with no other significant differences in radiographic or SRS outcomes (Ant = 4.8 ± 1.0 levels vs post = 6.1 ± 1.0 levels, P < 0.0001). When the dLOF was standardized to L3, the anterior approached provided significantly greater lumbar Cobb percent correction than the posterior approach (Ant = 69.1% ± 12.6% vs post = 54.6% ± 16.4%, P = 0.004), with no other significant radiographic or SRS score differences between approaches.
CONCLUSION Surgeons treating Lenke 5c curves with a posterior instrumentation and fusion vs an anterior approach include more motion segments, even with a selective fusion. When controlled for the distal level of fixation, the anterior approach provides greater correction of the thoracolumbar curve.
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Huitema GC, Jansen RC, van Ooij A, Punt IM, van Rhijn LW. Predictability of spontaneous thoracic curve correction after anterior thoracolumbar correction and fusion in adolescent idiopathic scoliosis. A retrospective study on a consecutive series of 29 patients with a minimum follow-up of 2 years. Spine J 2015; 15:966-70. [PMID: 23958296 DOI: 10.1016/j.spinee.2013.06.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Revised: 03/19/2013] [Accepted: 06/01/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT According to the Lenke classification, a Type 5 adolescent idiopathic scoliosis can be surgically treated with selective anterior thoracolumbar or lumbar fusion. PURPOSE This study aims to predict the spontaneous correction of the unfused thoracic curve after anterior thoracolumbar fusion and to study whether age is of influence on this predictability. STUDY DESIGN Retrospective study on a consecutive series of patients. PATIENT SAMPLE Of a consecutive series of 38 patients with idiopathic thoracolumbar scoliosis, Lenke type 5, 29 patients were included in the study. All patients were treated with anterior spinal fusion and instrumentation. A minimum follow-up of 2 years was available for all patients (mean, 4 years; range, 2-17 years). To investigate the influence of age on the outcome, we divided the group into two subgroups: an adolescent (n=13) and an adult age group (n=16). The mean age in the adolescent group was 17 (range, 13-21 years) and 38 years (range, 22-54 years) in the adult group. OUTCOME MEASURES Physiological measures include coronal Cobb angle, apical vertebral translation (AVT) and apical vertebral rotation (AVR), shoulder tilt, trunk shift, L4 tilt, and pelvic tilt. Relative corrections were computed for the thoracolumbar and thoracic curves in each patient using the following formula: (preoperative curve-postoperative curve)/preoperative curve×100 (%). The correlation coefficient between the relative (%) corrections of the thoracic and thoracolumbar curves was calculated for the whole group as for the two age subgroups. METHODS For radiographic evaluation, we used standing anteroposterior and lateral projections of the thoracolumbar spine to determine Cobb angle, AVT and AVR, and coronal balance. RESULTS Both the thoracolumbar and thoracic curves in the whole group improved after surgery (45% and 19%, respectively, p<.01). In the adolescent age group, a significant correlation between the relative (%) correction of the thoracolumbar curve and the relative (%) correction of the thoracic curve was found (R=0.704; p=.01) and between age and relative (%) correction of the thoracic curve (R=-0.805; p<.01). CONCLUSIONS These results show that the spontaneous correction of the thoracic curve is a reflection of the thoracolumbar curve correction in adolescent thoracolumbar idiopathic scoliosis. Moreover, the predictability of the thoracic curve correction in the individual patient seems to decrease with increasing age of the patient.
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Affiliation(s)
- Geertje C Huitema
- Department of Orthopaedic Surgery, Westfriesgasthuis, PO Box 600, 1620 AR Hoorn, The Netherlands.
| | - Rob C Jansen
- Department of Orthopaedic Surgery, Maastricht University Medical Center, PO Box 5800, 6202 AZ Maastricht, The Netherlands; Research School CAPHRI, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - André van Ooij
- Department of Orthopaedic Surgery, Viecuri, PO Box 1926, 5900 BX Venlo, The Netherlands
| | - Ilona M Punt
- Department of Orthopaedic Surgery, Maastricht University Medical Center, PO Box 5800, 6202 AZ Maastricht, The Netherlands; Research School CAPHRI, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Lodewijk W van Rhijn
- Department of Orthopaedic Surgery, Maastricht University Medical Center, PO Box 5800, 6202 AZ Maastricht, The Netherlands; Research School CAPHRI, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
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A rule-based algorithm can output valid surgical strategies in the treatment of AIS. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 24:1370-81. [DOI: 10.1007/s00586-014-3736-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 12/19/2014] [Accepted: 12/21/2014] [Indexed: 10/24/2022]
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The effect of unfused segments in coronal balance reconstitution after posterior selective thoracolumbar/lumbar fusion in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2014; 39:2042-8. [PMID: 25202933 DOI: 10.1097/brs.0000000000000602] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective radiographical analysis. OBJECTIVE To assess the effect of unfused segments in the reconstitution of coronal balance after posterior selective thoracolumbar/lumbar (TL/L) curve fusion for adolescent idiopathic scoliosis. SUMMARY OF BACKGROUND DATA Current literature suggests that compensatory changes occur after selective TL/L curve fusion surgery. Hitherto, the roles of the unfused levels in coronal balance reconstitution have not been fully understood. METHODS Radiographical data of patients with idiopathic scoliosis who underwent selective posterior TL/L curve fusion Peking Union Medical College Hospital before October 2011 with a minimum of 2 years of follow-up period were retrospectively analyzed. Changes of coronal trunk shift during the follow-up period were studied and multiple linear regression analysis was performed to determine its correlation with changes of upper and lower curve of unfused thoracic segments, instrumented segments angle, distal unfused segments angle, and coronal sacral inclination. RESULTS A total of 43 patients were included in this study. Preoperative and first erect radiographs demonstrated trunk shifts of 21.1 mm and 18.7 mm respectively, showing no significant differences (P = 0.205). At the last follow-up, it compensated to 9 mm, which showed significant differences (P < 0.01). Regression analysis of all patients showed that coronal trunk shift changes only correlated with distal unfused segment angle changes. Subgroup analysis based on the magnitude of preoperative thoracic curve found that only distal unfused segments had an impact on coronal balance reconstitution. However, subgroup analysis based on the flexibility of preoperative thoracic curve showed that both proximal unfused thoracic segments and distal unfused lumbar segments contributed to coronal balance compensation in patients with a thoracic curve flexibility rate of more than 70%. CONCLUSION The reconstitution of coronal balance was mainly compensated by distal unfused segments after selective posterior fusion of TL/L idiopathic scoliosis. The effect of unfused thoracic segments in coronal balance reconstitution mainly depended on its flexibility.
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Comparison of the Combined Anterior-Posterior Approach versus Posterior-Only Approach in Scoliosis Treatment. Asian Spine J 2014; 8:8-12. [PMID: 24596599 PMCID: PMC3939375 DOI: 10.4184/asj.2014.8.1.8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 10/29/2012] [Accepted: 10/31/2012] [Indexed: 11/23/2022] Open
Abstract
Study Design This is descriptive analytical study. Purpose The present study aims at comparing treatment results found between the two groups comprising of patients who underwent posterior spinal fusion using thoracic pedicle screws and the ones who underwent combined anterior-posterior method, respectively. Overview of Literature There was controversy about surgical techniques including anterior, posterior, or a combined anterior-posterior approaches are applied to treat non-congenital scoliosis with surgical indications. Methods Medical records of 50 patients suffering from thoracic non-congenital scoliosis with curves exceeding 70° were reviewed. In this study, 25 patients who underwent posterior spinal fusion using thoracic pedicle screws were compared with 25 patients who underwent combined anterior-posterior method. Results Patients treated through posterior-only and combined approaches were respectively hospitalized for 11.84±5.18 and 26.5±5.2 days (p=0.001). There was a significant difference between these two groups considering intensive care unit admission duration (p=0.001), correction in sagittal view of X-ray (p=0.01), and number of days the patients underwent traction (0.001). Finally, coronal view was corrected without any significant difference (p=0.2). Conclusions According to our findings, it is hypothesized that posterior-only method is associated with some significant advantages and is an advisable method in patients with severe scoliosis over than 70°.
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Maurice B. Anterior instrumentation (dual screws single rod system) for the surgical treatment of idiopathic scoliosis in the lumbar area: a prospective study on 33 adolescents and young adults, based on a new system of classification. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2012; 22 Suppl 2:S149-63. [PMID: 22644435 DOI: 10.1007/s00586-012-2343-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 03/01/2012] [Accepted: 04/19/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES/PURPOSE The choice of anterior instrumentation in the treatment of lumbar scoliosis in adolescents and young adults is not a new topic for the authors. The first results achieved using the Dwyer surgical modality were reported by one of the authors followed by the results achieved using Zielke (VDS) instrumentation. Today, new techniques and new instrumentations have been developed that challenge the instrumentation choices. Here we describe how the new system of classification of scoliotic curves we developed has been used as a basis for treating idiopathic scoliosis in lumbar area in adolescents and young adults using an anterior approach. MATERIALS A prospective study was carried out between 1998 and 2010 at two hospital centers on 33 adolescents and young adult with idiopathic lumbar scoliosis involving curves of three kinds, on whom surgical treatment was performed using a single solid rod. Topography of curves: our system of classification includes curves corresponding to the following three type of scoliosis: Type K I: double thoracic and lumbar curves (lumbar predominant) scoliosis (17 cases) mean age 16 years all female patients. Mean Cobb angle of lumbar curve 41°. Mean Cobb angle of thoracic curve 28°. The lumbar curve was left hand convex in 15 cases and right hand convex in 2 cases. Horizontal tilting of L4 mean value 22°. C7 offset mean value 3 cm. Type K IV A: unbalanced thoracolumbar scoliosis (13 cases) mean age 17 years, ten female patients and three male patients. Mean Cobb angle of thoracolumbar curve 39°. The thoracolumbar curve was left hand convex 4 times and right hand convex 9 times. Horizontal tilting of L4 mean value 18°. C 7 offset mean value 2.5 cm. Type K VI A: real lumbar (three cases). Age: 17, 15 and 13 years; all female patients. Cobb angle of the lumbar curve 66°, 29° and 70° (all LH convex). Horizontal tilting of L4: 40°, 20° and 46°. C 7 offset: 7 cm, 1 cm and 4 cm. METHODS Surgical instrumentation: We used the EUROS AZUR anterior instrumentation for all the procedures. Cages have been used on five patients at the lower stages. Number of vertebrae instrumented: mean five vertebrae. The patients did not wear postoperative orthosis. Mean duration of procedure: 3 h 50 min. Mean blood loss: 350 cm(3). RESULTS Type K I scoliosis (17 cases): Mean follow-up: 6 years. Correction of the lumbar curve Cobb angle: the mean angle has been corrected from 41° to 21°. Number of vertebrae instrumented: 4:6 times and 5:11 times. Correction of the upper thoracic curve Cobb angle: mean angle corrected from 28° to 19°. Correction of L4 horizontal tilting: mean residual was 7°. Correction of C 7 offset: mean 0.7 cm. Type K IV A scoliosis (13 cases): mean follow-up: 4 years. Correction of the lumbar curve Cobb angle: the mean angle has been corrected from 39° to 16°. Mean number of instrumented vertebrae: 5 (4:4 times, 5:6 times and 6:3 times.) Correction of L4 horizontal tilting: mean residual 5°. Correction of C 7 offset: mean 0.7 cm. Type K VI A scoliosis (three cases): mean follow-up: 7, 2 and 4 years; Correction of the lumbar curve Cobb angle: the angles have been corrected from 66° to 15°, from 29° to 11° and from 70° to 28°. Number of instrumented vertebrae: 5, 4 and 6. Correction of L4 horizontal tilting: residual tilting of 8°, 7° and 17°. Correction of C 7 offset: 1 cm, 0 cm and 1 cm. COMPLICATIONS There has been no report early or late septic or vascular or neurological complications. Instrumentation failure: there were three cases of screw breakage, all occurred on the lowest implant. Revision surgery was undertaken in both cases, only the last plate needed to be replaced and the rod could be kept without any other modification of the construct. In both cases, fusion has been achieved without any loss of correction. The mean loss of correction of the main curve was 2.5° for the three series. CONCLUSIONS Anterior instrumentation of lumbar idiopathic scoliosis gives highly satisfactory morphological and functional results, since the lumbar musculature is spared and the instrumentation placed at the apex of the curvature has selective effects. Despite our preference and that of other surgeons throughout the world for anterior instrumentation, we are still a minority in comparison with the users of posterior instrumentation. There are several reasons for this reticence, including surgeons' training and ideas about pedicular screw fixation, but the main reason has been the lack of a sufficiently exact system of classification. Previous comparative studies between the anterior and posterior approaches have been biased by the use of an excessively restrictive mode of classification (lumbar/thoracolumbar) of the curves. Real lumbar scoliosis, unbalanced thoracolumbar scoliosis and thoracic and lumbar double curve (lumbar predominant) scoliosis should be properly defined before being compared.
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Min K, Haefeli M, Mueller D, Klammer G, Hahn F. Anterior short correction in thoracic adolescent idiopathic scoliosis with mini-open thoracotomy approach: prospective clinical, radiological and pulmonary function results. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2012; 21 Suppl 6:S765-72. [PMID: 22274321 DOI: 10.1007/s00586-012-2156-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Revised: 01/04/2012] [Accepted: 01/08/2012] [Indexed: 11/29/2022]
Abstract
INTRODUCTION This is a prospective study of adolescent patients in whom idiopathic thoracic scoliosis was corrected by short anterior fusion through a mini-open thoracotomy approach. Clinical, radiological and pulmonary function results of minimal 2-year (2-6) follow-up are presented. MATERIALS AND METHODS Consecutive 62 patients with Lenke 1 and 2 curves, having main thoracic scoliosis of up to 75°, were prospectively included. The shoulder imbalance in Lenke 2 patients was less than 20 mm. Thoracic scoliosis was corrected by short anterior fusion. The thoracic spine was exposed by an 8-cm mini-open thoracotomy incision. The operation technique and choosing of fusion levels are thoroughly described. Complete 360° discectomies and convex side vertebral endplates osteotomies are essential for deformity corrections with short fusions. Single-rod 5.5-mm titanium implants were used. The age at the time of operation was mean 15.2 years; 56 patients had a single thoracic curve and 6 patients had a double thoracic curve. There were almost equal numbers of patients with lumbar modifier A, B or C. The average length of fusion was 5.5 (4-7) vertebrae. The average length of fusion was 3.5 (2-6) vertebrae shorter than the average curve length. RESULTS The instrumented thoracic curves improved by 58.3% at 6 weeks and 56.3% at the last follow-up. Apex thoracic vertebral rotation improved by 73.78% at 6 weeks and 76.24% at the last follow-up. The non-instrumented upper thoracic curve improved by 25% in double thoracic scoliosis, where the mid-thoracic curve was selectively fused, and the non-instrumented lumbar curves improved by 33.9% at the last follow-up. The radiological changes from 6 weeks to the last follow-up were statistically not significant. The clinical rib hump improved by 54% at the last follow-up. There were no significant changes in the pulmonary function. FVC% was 81.04% preoperatively, 76.41% at 6 months and 80.38% at the 2-year follow-up. The results of SRS 24 questionnaire improved from a total of 61.40 points preoperatively to 100.50 points at 6 months and 98.62 points at the 2-year follow-up. There were no neurological or thoracotomy related complications, no pseudarthrosis, no implant pullout or breakage. CONCLUSION A good deformity correction without loss of correction or adding on, a good cosmetic result and good patient's satisfaction were achieved through shorter than end-to-end thoracic fusions. The radiological residual deformity is acceptable. Anterior correction of thoracic scoliosis with a short spinal fusion is recommended to keep the large part of the spine mobile. A very short fusion, small thoracotomy incision, low-profile implants and complete closure of parietal pleura are keys to prevent reduction in postoperative lung function.
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Affiliation(s)
- Kan Min
- Department of Orthopaedics, Balgrist Clinic, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
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He JW, Bai GH, Ye XJ, Liu K, Yan ZH, Zhang X, Wang XY, Huang YX, Yu ZK. A comparative study of axis-line-distance technique and Cobb method on assessing the curative effect on scoliosis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2011; 21:1075-81. [PMID: 22105310 DOI: 10.1007/s00586-011-2081-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Revised: 10/24/2011] [Accepted: 11/12/2011] [Indexed: 11/30/2022]
Abstract
PURPOSE To compare the axis-line-distance technique (ALDT) and Cobb method for therapeutic evaluation of scoliosis. METHODS Fifty-seven patients with scoliosis were treated in our hospital, 47 underwent conservative bracing therapy and 10 underwent surgery. Based on 171 full-spine X-ray images obtained from these 57 cases before treatment, during conservative treatment or surgery, and at final follow-up after removing the brace or after surgery, two radiologists independently measured and calculated the correction rate during treatment and at final follow-up and the rate of correction loss after treatment with the ALDT and Cobb methods. Paired t-test and correlation analysis were performed. RESULTS Based on the ALDT, the lateral deviations of the apical vertebrae before treatment, during treatment, and at final follow-up were 31 ± 14 mm, 16 ± 8 mm, and 20 ± 8 mm, respectively; the correction rates during treatment and at final follow-up were 48.7 ± 21.2% and 37.6 ± 14.2%, respectively, and the rate of correction loss after treatment was 11.3 ± 6.5%. The Cobb angles of scoliosis before treatment, during treatment, and at final follow-up were 34 ± 14°, 19 ± 7°, and 22 ± 6°, respectively; the correction rates during treatment and at final follow-up were 44.4 ± 17.3% and 33.9 ± 14.4%, respectively, and the rate of correction loss after treatment was 11.4 ± 4.3%. Calculation of the correction rate during treatment differed significantly between the two radiologists when using the Cobb method (P < 0.05); their calculations of the correction rate and rate of correction loss were not different (P > 0.05). The measurement data of the two radiologists using the Cobb method showed a weak to moderate correlation (r = 0.49, 0.57, and 0.51, respectively). When using the ALDT, there were no significant differences between the radiologists in their measurements of the correction rate during and after treatment (P > 0.05) or in the rate of correction loss. The measurement data of the two radiologists using the ALDT showed a good to excellent correlation (r = 0.92, 0.93, and 0.90, respectively). CONCLUSION The ALDT is better than the Cobb method for therapeutic evaluation of scoliosis during treatment and at follow-up visits.
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Affiliation(s)
- Jia-Wei He
- Radiology Department, The 2nd Affiliated Hospital of Wenzhou Medical College, #109 Xue Yuan Xi Lu, Wenzhou, China
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Maurice B, Jean-Marie G, Jean-Michel T. Taking the shoulders and pelvis into account in the preoperative classification of idiopathic scoliosis in adolescents and young adults (a constructive critique of King's and Lenke's systems of classification). EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2011; 20:1780-7. [PMID: 21769446 DOI: 10.1007/s00586-011-1899-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2011] [Revised: 06/18/2011] [Accepted: 06/28/2011] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The surgical strategies to treat idiopathic scoliosis on adolescents and young adults need a basic reliable classification. King's and Lenke's classification are inappropriate because they fail to take shoulders and pelvis into account. METHODS We propose the answer for the following three questions: 1. Why are we challenging King's and Lenke's systems of classification? 2. How many frontal and possibly sagittal curves do we need to be able to develop a strategy which is applicable to almost all cases? 3. How should scoliotic curves be classified? RESULTS In double thoracic and lumbar (thoracic predominant) scoliosis, the concepts of "pelvis included" and "pelvis excluded" are not simply based on a semantic distinction, but correspond to different physiopathological entities and require different surgical strategies. In double thoracic curves the concepts of "real double thoracic" and "potential double thoracic" curves are keys to obtain post operative shoulder balance. In lumbar scoliosis the concepts of "real lumbar" and "lumbosacral" curves are necessary to compare results of posterior or anterior approach in surgical strategies. The system proposed in this work involves ten basic curves. CONCLUSION The surgical strategies used to treat idiopathic scoliosis in adolescents and young adults depend on the school of thought as to whether the anterior or posterior approach is preferable and the extent of the vertebral instrumentation. A consensus system of classification of scoliotic curves is required to compare the results obtained using various methods. This has been done in the improved version of King's system proposed here and should provide an efficient tool for use in comparative studies on surgical methods.
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Affiliation(s)
- Bergoin Maurice
- Department of Orthopaedic Surgery, Clinique Axium, Aix-en-Provence, France.
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Han IH, Chin DK, Kim KS. Short segment anterior correction of adolescent idiopathic scoliosis. J Korean Neurosurg Soc 2008; 44:52-6. [PMID: 19096658 DOI: 10.3340/jkns.2008.44.1.52] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Accepted: 07/07/2008] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The purpose of this study was to introduce our surgical experiences of scoliosis and to evaluate the effectiveness of anterior correction and fusion in adolescent idiopathic scoliosis (AIS). METHODS Between August 2004 and August 2007, four patients with AIS were treated with anterior segmental fusion and fixation at our hospital. Mean follow-up period was 9 (6-12) months. The average age was 14.0 (13-15) years. According to Lenke classification, three patients showed Lenke 1 curve and one patient with Lenke 5 curve. Single rod instrumentation was performed in one patient, dual rod instrumentation in one patient and combined rod instrumentation in two patients. Coronal Cobb measurements were performed on all curves in thoracic, thoracolumbar and, lumbar spine and the angle of hump was measured by a scoliometer pre- and postoperatively. RESULTS The average operative time was 394 minutes (255-525) with an average intraoperative blood loss of 1,225 ml (1,000-1,700). The mean period of hospital stay was 19.3 days and there was no complication related to the surgery. The mean Cobb angle was reduced from 43.3 degrees to 14.8 degrees (65.8% correction) postoperatively and the rib hump corrected less than 5 degrees . All patients and their parents were satisfied with the deformity correction. CONCLUSION Anterior spinal correction and fusion of AIS with Lenke 1 and 5 curve showed excellent deformity correction without any complications. In particular, we recommend anterior dual rod instrumentation because of mechanical stability, better control of kyphosis, and a higher fusion rate.
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Affiliation(s)
- In Ho Han
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yongdong Severance Hospital, Yonsei University, College of Medicine, Seoul, Korea
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Comparison of compensatory curve spontaneous derotation after selective thoracic or lumbar fusions in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2008; 33:2643-7. [PMID: 19011546 DOI: 10.1097/brs.0b013e3181891806] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective review of a multicenter prospectively collected series of adolescent idiopathic scoliosis (AIS) patients. OBJECTIVE To compare uninstrumented compensatory curve spontaneous derotation of the rib hump and lumbar prominence after selective lumbar or thoracic fusions in AIS. SUMMARY OF BACKGROUND DATA Coronal correction of the unfused minor curve after selective fusions in AIS has been well-documented previously. However, little has been reported regarding spontaneous correction in the axial plane of the unfused minor curve after selective AIS surgery. METHODS Patients with minimum 2-year follow-up after either a selective thoracic fusion (STF) (lowest instrumented vertebrae L2 or above), or a selective lumbar fusion (upper instrumented vertebrae T9 or below) for AIS, with an initial scoliometer value of >or=5 degrees in the minor curve were analyzed. Prospectively acquired preoperative and 2-year postoperative radiographic and scoliometer measurements of both the fused and unfused curves were compared using repeated measures and univariate analysis of variance. The data were checked for normality and equal variances, and the level of significance was set at P <or= 0.05. RESULTS In patients that underwent a STF (n = 83), the mean thoracic rib hump improved significantly from a preoperative value of 15 degrees +/- 5 degrees to 7 degrees +/- 4 degrees at the 2-year follow-up (P <or= 0.001). The mean lumbar prominence of the unfused curve also spontaneously improved significantly in this group of patients during the follow-up period from 9 degrees +/- 3 degrees to 4 degrees +/- 3 degrees (P <or= 0.001). In patients who underwent a selective lumbar fusion (n = 27), the mean lumbar prominence corrected significantly from a preoperative value of 11 degrees +/- 5 degrees , to a 2-year postoperative value of 3 degrees +/- 3 degrees (P <or= 0.001). The mean thoracic rib hump, however, only changed from 8 degrees +/- 3 degrees before surgery to 6 degrees +/- 3 degrees at the 2-year follow-up. This change was not found to be statistically significant (P = 0.14). The spontaneous lumbar prominence correction of 49% was significantly greater than the spontaneous thoracic rib hump correction of 26% (P = 0.04). CONCLUSION Axial plane rotational correction of the unfused minor curve in patients undergoing selective fusions does occur. Significant spontaneous correction of a thoracic rib hump after a selective lumbar fusion should not be anticipated, whereas an approximate 50% reduction in the lumbar prominence was the average after selective thoracic fusions.
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Weiss HR. Adolescent idiopathic scoliosis (AIS) - an indication for surgery? A systematic review of the literature. Disabil Rehabil 2008; 30:799-807. [PMID: 18432438 DOI: 10.1080/09638280801889717] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE Historically, the treatment options for AIS, the most common form of scoliosis are: Exercises, in-patient rehabilitation, braces and surgery. While there is evidence in the form of prospective controlled studies that Scoliosis Intensive Rehabilitation (SIR) and braces can alter the natural history of the condition, there is no review on prospective controlled trials for surgical treatment. The aim of this review was to perform a systematic search of the Pub Med literature to reveal the evidence on scoliosis surgery. METHODS A systematic review has been performed using the Pub Med database. Literature has been searched for the outcome parameter; 'rate of progression' and only prospective controlled studies that have considered the treatment versus the natural history have been included. RESULTS No controlled study, not in the short, mid or long term, searched within the review, has been found to reveal evidence to support the hypothesis that the effects of surgery as a treatment option for AIS is superior to natural history. CONCLUSIONS No evidence has been found in terms of prospective controlled studies to support surgical intervention from the medical point of view. In the light of the unknown long-term effects of surgery and in concluding on the lack of evidence already found that surgery might change the signs and symptoms of scoliosis, a randomized controlled trial (RCT) is long overdue. Until such a time that such evidence exists, there can be no medical indication for surgery. The indications for surgery are limited for cosmetic reasons in severe cases and only if the patient and the family agree with this.
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Affiliation(s)
- Hans-Rudolf Weiss
- Asklepios Katharina Schroth, Spinal Deformities Rehabilitation Centre, Bad Sobernheim, Germany.
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