Choosing Fusion Levels in Adolescent Idiopathic Scoliosis

Trobisch, Per; Ducoffe, Aaron R.; Lonner, Baron S.; Errico, Thomas J.

doi:10.5435/jaaos-21-09-519

Cited by 58 publications

(63 citation statements)

References 40 publications

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“…There are of course other factors that influence adjacent segment failure such as rigidity in adult spine deformities or the incorrect selection of fusion levels. These possible confounding factors were carefully considered before and during the surgery to optimize the outcome, maintain mobility/flexibility and avoidance of proximal or distal segment failure, as previous studies have analysed [ 37 – 39 ]. Even performance of an osteotomy confers a large risk of possible complications, but the outcome can improve significantly with such a procedure [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

Perioperative complications after surgical treatment in degenerative adult de novo scoliosis

Simon

Halm

Quante

2018

BMC Musculoskelet Disord

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BackgroundDegenerative adult de novo (DAD) scoliosis appears characteristically in the sixth or seventh decade with symptoms of severe back pain and radiculopathy or spinal claudication. The aim of this study was to enhance the knowledge of perioperative complications and detect possible risk factors in this selective DAD scoliosis surgery.MethodsThis retrospective study included only patients with DAD scoliosis undergone correction spondylodesis with previous failure of conservative treatment. Excluded were patients with other types of scoliosis and previous fusion surgeries. Patient epidemiological data, medical comorbidities and treatments were included. Intraoperative data and perioperative complications were documented. Analyses regarding early, late and no complications were undertaken.ResultsA total of 92 patients with a mean age of 67.29 ± 7.93 years and clinical follow-up visits of minimum 12 months were included. On average, 5.26 ± 2.24 segments were fused. Early complications (e.g. wound healing defects, paresis, screw loosing) occurred in 23 patients and often required a re-operation. Cardiac arrhythmias, pacemaker and coumarin derivative therapies were associated with increased perioperative complications. The transforaminal lumbar interbody fusion technique was associated with early complications. Adjacent segment failure occurred in 36% and was the major late complication. Twenty patients did not have any complications in the minimum follow-up.ConclusionsThis study analysed a selective DAD scoliosis collective and its’ surgical treatment outcomes. It identified numerous perioperative complications (adjacent segment failure, postoperative paresis and epidural hematoma) and multiple possible predisposing risk factors (e.g. operative techniques and anti-coagulation therapies). This here gained information raises awareness in preoperative patient selection and preparation. Further studies in DAD scoliosis and a risk-adjusted patient selection/preparation are needed to improve treatment quality and outcomes.

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Section: Discussionmentioning

confidence: 99%

Perioperative complications after surgical treatment in degenerative adult de novo scoliosis

Simon

Halm

Quante

2018

BMC Musculoskelet Disord

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“…4,8,10 The stable vertebra in scoliosis, which is the most cranial vertebra bisected by the central sacral vertical line, is often designated as the LIV unless the presumed end level is kyphotic or degenerative. In primary kyphotic deformities, the SSV concept can be important for determining the LIV as well.…”

Section: Discussionmentioning

confidence: 99%

Distal Fusion Level Selection in Scheuermann’s Kyphosis: A Comparison of Lordotic Disc Segment Versus the Sagittal Stable Vertebrae

Kim

Nemani

Boachie-Adjei

et al. 2017

Global Spine Journal

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Study Design:Retrospective study.Objective:To compare 2 methods of selecting the lowest instrumented vertebra (LIV) on the rates of revision surgery for distal junctional kyphosis (DJK) following treatment for Scheuermann’s kyphosis (SK).Methods:A retrospective review of patients who have undergone surgical treatment for SK was performed. Forty-four patients were divided into 2 groups based on intervention: Group 1 (n = 26) included patients who had an LIV distal to or at the sagittal stable vertebrae (SSV), and Group 2 (n = 18) included patients who had an LIV proximal to the SSV. For each group, demographic, radiographic, and revision surgery data was analyzed.Results:The average follow-up was 3.1 years. There were no differences among demographic variables between the groups. Preoperative and postoperative thoracic kyphosis, lumbar lordosis, and sagittal balance were not different between groups. Postoperatively, Group 1 demonstrated a significantly greater average lordotic disc angle below the LIV compared with Group 2 (Group 1, −6.2 ± 4.3° vs Group 2, −2.9 ± 5.8°; P = .02). In a subgroup analysis, extending fusions to the sagittal stable vertebra rather than the first lordotic disc resulted in fewer distal LIV complications necessitating revision surgery compared with fusing short of the SSV (5% vs 36.3%, P = .04).Conclusion:The SSV method may reduce complications secondary to distal junctional failure, but at the expense of incorporating additional motion segments in a typically young population.

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“…Instrumented scoliosis surgery was first performed in the 1960s [1], subsequent to which, device and technique modifications since then have led to improved surgical results. The goals of surgical management of adolescent idiopathic scoliosis (AIS) include maintaining coronal and sagittal alignment, producing level shoulders, correcting deformity, and saving motion segments [2]. Classification systems for AIS are useful for surgical planning and for comparing postoperative results.…”

Section: Background -Scoliosismentioning

confidence: 99%

Towards a Deformable Multi-surface Approach to Ligamentous Spine Models for Predictive Simulation-Based Scoliosis Surgery Planning

Audette

Schmid

Goodmurphy

et al. 2019

Lecture Notes in Computer Science

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Scoliosis correction surgery is typically a highly invasive procedure that involves either an anterior or posterior release, which respectively entail the resection of ligaments and bone facets from the front or back of the spine, in order to make it sufficiently compliant to enable the correction of the deformity. In light of progress in other areas of surgery in minimally invasive therapies, orthopedic surgeons have begun envisioning computer simulation-assisted planning that could answer unprecedented what-if questions. This paper presents preliminary steps taken towards finite elements simulation-based surgery planning that will provide answers as to how much anterior or posterior release is truly necessary, provided we also establish the amplitude of surgical forces involved in corrective surgery. This question motivates us to pursue a medical image-based anatomical modeling pipeline that can support personalized finite elements simulation, based on models of the spine that not only feature vertebrae and intervertebral discs (IVDs), but also descriptive ligament models. This paper suggests a way of proceeding, based on the application of deformable multi-surface Simplex model to a CAD-based representation of the spine that makes explicit all spinal ligaments, along with vertebrae and IVDs. It presents a preliminary model-based segmentation study whereby Simplex meshes of CAD vertebrae are registered to the subject's corresponding vertebrae in CT data, which then drives ligament and IVD model registration by aggregation of neighboring vertebral transformations. This framework also anticipates foreseen improvements in MR imaging that could achieve better contrasts in ligamentous tissues in the future.

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Choosing Fusion Levels in Adolescent Idiopathic Scoliosis

Cited by 58 publications

References 40 publications

Perioperative complications after surgical treatment in degenerative adult de novo scoliosis

Perioperative complications after surgical treatment in degenerative adult de novo scoliosis

Distal Fusion Level Selection in Scheuermann’s Kyphosis: A Comparison of Lordotic Disc Segment Versus the Sagittal Stable Vertebrae

Towards a Deformable Multi-surface Approach to Ligamentous Spine Models for Predictive Simulation-Based Scoliosis Surgery Planning

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