Combined anterior and posterior instrumentation in severe and rigid idiopathic scoliosis

Bullmann, Viola; Halm, H.; Schulte, Tobias L.; Lerner, Thomas; Weber, Thomas P.; Liljenqvist, Ulf

doi:10.1007/s00586-005-1016-1

Cited by 75 publications

(78 citation statements)

References 21 publications

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“…Kuklo et al [27] used 352 thoracic screws in 20 patients (17.6 screws/case) to correct idiopathic scoliosis over 90°and achieved 68% correction. The scoliosis correction rate of these two studies [14,27] adopting pedicle screws, was surprisingly high, similar to that achieved by Bullman et al [10] using a combination of anterior instrumentation and a posterior hybrid construct. Most of the literature on the surgical treatment of severe idiopathic thoracic curves shows more contained values, generally lower than 60% regardless of the technique used [3,9,26,53,54].…”

Section: Discussionsupporting

confidence: 82%

“…Later, the most common treatment was anterior release with an open thoracotomy [10,13,26,44,46] followed by posterior instrumented fusion. Halo-traction between anterior release and posterior instrumentation was often applied [42].…”

Section: Introductionmentioning

confidence: 99%

“…Halo-traction between anterior release and posterior instrumentation was often applied [42]. Sometimes, in highly rigid scoliosis, this combined program was preceded by an additional posterior release [10].The correction rate of severe idiopathic curves with the combined treatment was 45-47%, using Harrington instrumentation [13] or the multiple hook construct [46], 52% using Zielke instrumentation with Harrington rod [26], and up to 67%, using anterior instrumentation and posterior hybrid construct [10]. The combined anterior and posterior procedure was performed in 1-or 2-stage surgery according to different authors with different outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Posterior fusion only for thoracic adolescent idiopathic scoliosis of more than 80°: pedicle screws versus hybrid instrumentation

et al. 2008

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The treatment of thoracic adolescent idiopathic scoliosis (AIS) of more than 80°traditionally consisted of a combined procedure, an anterior release performed through an open thoracotomy followed by a posterior fusion. Recently, some studies have reassessed the role of posterior fusion only as treatment for severe thoracic AIS; the correction rate of the thoracic curves was comparable to most series of combined anterior and posterior surgery, with shorter surgery time and without the negative effect on pulmonary function of anterior transthoracic exposure. Compared with other studies published so far on the use of posterior fusion alone for severe thoracic AIS, the present study examines a larger group of patients (52 cases) reviewed at a longer follow-up (average 6.7 years, range 4.5-8.5 years). The aim of the study was to evaluate the clinical and radiographic outcome of surgical treatment for severe thoracic ([80°) AIS treated with posterior spinal fusion alone, and compare comprehensively the results of posterior fusion with a hybrid construct (proximal hooks and distal pedicle screws) versus a pedicle screw instrumentation. All patients (n = 52) with main thoracic AIS curves greater than 80°(Lenke type 1, 2, 3, and 4), surgically treated between 1996 and 2000 at one institution, by posterior spinal fusion either with hybrid instrumentation (PSF-H group; n = 27 patients), or with pedicle screw-only construct (PSF-S group; n = 25 patients) were reviewed. There were no differences between the two groups in terms of age, Risser's sign, Cobb preoperative main thoracic (MT) curve magnitude (PSF-H: 92°vs. PSF-S: 88°), or flexibility on bending films (PSF-H: 27% vs. PSF-S: 25%). Statistical analysis was performed using the t test (paired and unpaired), Wilcoxon test for nonparametric paired analysis, and the Mann-Whitney test for non-parametric unpaired analysis. At the last follow-up, the PSF-S group, when compared to the PSF-H group had a final MT correction rate of 52.4 versus 44.52% (P = 0.001), with a loss of -1.9°versus -11.3°( P = 0.0005), a TL/L correction of 50 versus 43% (ns), a greater correction of the lowest instrumented vertebra translation (-1.00 vs. -0.54 cm; P = 0.04), and tilt (-19°vs. -10°; P = 0.005) on the coronal plane. There were no statistically significant differences in sagittal and global coronal alignment between the two groups (C7-S1 offset: PSF-H = 0.5 cm vs. PSF-S = 0 cm). In the hybrid series (27 patients) surgery-related complications necessitated three revision surgeries, whereas in the screw group (25 patients) one revision surgery was performed. No neurological complications or deep wound infection occurred in this series. In conclusion, posterior spinal fusion for severe thoracic AIS with pedicle screws only, when compared to hybrid construct, allowed a greater coronal correction of both main thoracic and secondary lumbar curves, less loss of the postoperative correction achieved, and fewer revision surgeries. Posterior-only fusion with pedicle screws enabled a good and...

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Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Posterior fusion only for thoracic adolescent idiopathic scoliosis of more than 80°: pedicle screws versus hybrid instrumentation

et al. 2008

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“…In the past, the treatment of severe idiopathic scoliosis (Main curve over 80°Cobb) was performed by an anterior release with an open thoracotomy [1] followed by posterior instrumented fusion. Halo traction between anterior release and posterior instrumentation was sometimes applied.…”

Section: Introductionmentioning

confidence: 99%

“…Halo traction between anterior release and posterior instrumentation was sometimes applied. The correction rate of severe idiopathic curves with the combined treatment was 45-47 %, using Harrington instrumentation or the multiple hook construct [2]; a 52 % correction rate was recorded using Zielke instrumentation with Harrington rod, and this rose to as much as 67 %, using anterior instrumentation and posterior hybrid construct [1]. The combined anterior and posterior procedure was performed in one-or two-stage surgery by different authors with different outcomes.…”

Section: Introductionmentioning

confidence: 99%

Treatment of severe scoliosis with posterior-only approach arthrodesis and all-pedicle screw instrumentation

et al. 2013

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Purpose Posterior-only approach arthrodesis by all-pedicle screw instrumentation has a correction rate similar to correction obtained by traditional combined anterior/posterior approach surgery and avoids the complications associated with the thoracic approach. Methods We treated 25 patients, with a mean age 16.5 years, with severe adolescent idiopathic scoliosis by posterior-only approach using all-screw instrumentation arthrodesis. Mean scoliosis curve in Cobb degrees was 95°C obb. All cases were treated by the same senior surgeon, by free hand technique, without intraoperative neurophysiologic monitoring and spine navigation aids. Results Mean scoliosis curve after surgery was 37°Cobb. Mean follow-up was 4 years. No perioperative complications, curve progression or arthrodesis malunion were reported at the follow-up. Conclusions Posterior spinal fusion with pedicle screwonly instrumentation obtains a good and stable correction of severe scoliosis; compared to hybrid instrumentation, it allows a greater coronal correction of the deformity and less correction loss at the follow-up.

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Current concepts in scoliosis surgery

Seifert¹,

Bernstein²

Orthopaedic Spine Surgery

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Combined anterior and posterior instrumentation in severe and rigid idiopathic scoliosis

Cited by 75 publications

References 21 publications

Posterior fusion only for thoracic adolescent idiopathic scoliosis of more than 80°: pedicle screws versus hybrid instrumentation

Posterior fusion only for thoracic adolescent idiopathic scoliosis of more than 80°: pedicle screws versus hybrid instrumentation

Treatment of severe scoliosis with posterior-only approach arthrodesis and all-pedicle screw instrumentation

Current concepts in scoliosis surgery

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