Comparative analysis of pedicle screw versus hybrid instrumentation in adolescent idiopathic scoliosis surgery

Abstract

The expectations of both the patient and surgeon have been greatly revised in the last 10 years with the introduction of pedicle screws (PS) in spinal surgery. In this study, we have retrospectively evaluated and compared the results of PS instrumentation and the Hybrid System (HS), the latter consists of pedicle screws, sublaminar wire and hooks. The mean follow-up period was 60.1 months (range: 49-94 months) for the patients of the HS group and 29.3 months (range: 24-35 months) for those of the PS group. In the HS group, pedicle screws were used at the thoracolumbar junction and lumbar vertebra, the bilateral pediculotransverse claw hook configuration was used at the cranial end of the instrumentation, sublaminar wire was used on the concave side of the apical region and the compressive hook was used on the convex side. In the PS group, PS were used on the concave sides at all levels and on the convex side of the cranial and caudal end of instrumentation, in the transition zone and at the apex. The two groups were comparable for variables such as mean age, preoperative Cobb angle, thoracic kyphosis angle, lordosis angle, coronal balance, flexibility of the curve, apical vertebra rotation (AVR), apical vertebra rotation (AVT) and the number of vertebrae included in the fusion (p>0.05). The parameters of values of correction, ratio of correction loss, AV derotation, AVT correction ratio, amount of blood loss, operation time, postoperative global coronal and sagittal balance, thoracic kyphosis angle and lumbar lordosis angle were measured at the last follow-up and used for comparing the HS and PS groups. There was no statistically significant difference between the groups for correction ratio, postoperative coronal balance, postoperative thoracic kyphosis and lumbar lordosis angle, operation time, amount of blood loss and number of fixation points (p>0.05) The difference for the ratio of correction loss, AV derotation angle and the AVT correction ratio at the last follow-up visit and for the total follow-up period between the groups was found to be statistically significant (p<0.05). Although it is possible to obtain a similar amount of correction by either instrumentation system, the loss of correction seems to be lower with the more rigid PS construction. The PS system also has a stronger effect on vertebral bodies, thereby providing better AV de-rotation. There was no significant difference (p>0.05) between the groups in terms of correction rate, postoperative coronal and sagittal balance, operation time, blood loss and number of fixation points. This may indicate that anchor points are more important than the use -or not -of screws. Correction durability and AV de-rotation was better with PS instrumentation, while AVT was better corrected by HS instrumentation (p<0.05). We propose that the reason for the better correction of AVT with HS instrumentation is the forceful translation offered by the sublaminar wire at the apical region, while the reason for the better correction durability of the PS instr...

Use of the Universal Clamp in adolescent idiopathic scoliosis for deformity correction and as an adjunct to fusion: 2-year follow-up

“…However, among the patients with low preoperative values of T5-T12 kyphosis, the average T5-T12 kyphosis increased by 6°at 3 months and continued to improve thereafter, attaining an increase of 10°at 2 years. This improvement in thoracic kyphosis confirms previous results on the use of the UC for both AIS and neurologic scoliosis [13,16,20], and contrasts with a large body of evidence suggesting that conventional all-pedicle screw constructs tend to worsen flatness of the thoracic spine in AIS [3,4,7,8,[28][29][30][31][32][33] unless rod derotation is the predominant means used to correct coronal deformity (see Table 1) [6,[34][35][36][37]. Based upon a retrospective study of patients with Lenke type 1 AIS treated with all-pedicle screw instrumentation, Quan and Gibson recently concluded that the greater the coronal plane correction achieved with pedicle-screw constructs, the greater the loss of thoracic kyphosis [33].…”

Five-year clinical and radiographic outcomes using pedicle screw only constructs in the treatment of adolescent idiopathic scoliosis

“…In 1995, Suk et al [5] reported outcomes in 78 patients and noted improved coronal correction and less loss of correction at 2 years using screws when compared to hybrid constructs. Subsequently, other studies have shown pedicle screw constructs to provide greater immediate postoperative correction of coronal curvature, axial translation, and axial rotation [11][12][13]. Better maintenance of correction at 2 years has been reported in both fused and compensatory curves, as well as a reduction in the number of segments fused and a lower revision rate associated with pedicle screw constructs [12,15,16].…”

“…The development of CD instrumentation improved upon Harrington rod constructs, but correction of axial rotation remained suboptimal [3][4][5][6]. Most recently, the application of thoracic pedicle screws has improved upon many of the limitations from earlier constructs while providing maintenance of correction in the short-term [10][11][12][13][14][15].…”

Loss of apical vertebral derotation in adolescent idiopathic scoliosis: 2-year follow-up using multi-planar reconstruction computed tomography

“…plane on X-rays, even when PS constructs are used [2][3][4][5][6], although correction loss in the axial plane has not been well described.…”