Comparative Analysis of Pedicle Screw Versus Hybrid Instrumentation in Posterior Spinal Fusion of Adolescent Idiopathic Scoliosis

Kim, Yongjung J.; Lenke, Lawrence G.; Kim, Jung-Hoon; Bridwell, Keith H.; Cho, Samuel K.; Cheh, Gene; Sides, Brenda

doi:10.1097/01.brs.0000197865.20803.d4

Cited by 393 publications

(278 citation statements)

References 25 publications

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“…Some authors tried a combination of these two techniques and compared the results with pedicle screw systems and found similar results in terms of the junctional change, lowest instrumented vertebra, operative time and post-operative clinical outcome. However the pedicle screw system was still found to be superior in achieving a better major curve correction and lesser neurological complications [25].The risk can be minimized by better understanding of the anatomy and biomechanics involved in pedicle screw fixation [24,26,27]. The advantage of the hybrid system is that it can avoid the placement of pedicle screws in the upper thoracic spine, which is technically demanding and is fraught with the risk of neurological and vascular complications.…”

Section: Discussionmentioning

confidence: 99%

Scoliosis in Duchenne’s muscular dystrophy: a changing trend in surgical management

Arun

Srinivas²,

Mehdian³

2009

Eur Spine J

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A non-randomised retrospective study to compare the results of surgical correction of scoliosis in Duchenne's muscular dystrophy (DMD) patients using three different instrumentation systems-Sublaminar instrumentation system (Group A), a hybrid of sublaminar and pedicle screw systems (Group B) and pedicle screw system alone (Group C). Between 1993 and 2003, 43 patients with DMD underwent posterior spinal fusion and instrumentation. Group A (n = 19) had sublaminar instrumentation system, Group B (n = 13) had a hybrid construct and Group C (n = 11) was treated with pedicle system. The mean blood loss in Group A was 4.1 l, 3.2 l in Group B and 2.5 l in Group C. Average operating times in Group A, B and C were 300, 274 and 234 min, respectively. Mean pre-operative, post-operative and final Cobb angle in Group A was 50.05 ± 15.46°, 15.68 ± 11.23°and 21.57 ± 11.63°, Group B was 17.76 ± 8.50°, 3.61 ± 2.53°and 6.69 ± 4.19°and Group C was 25.81 ± 9.94°, 5.45 ± 3.88°, 8.90 ± 5.82°, respectively. Flexibility index or the potential correction calculated from bending radiographs were 60 ± 6.33, 70 ± 4.65 and 67 ± 6.79% for Group A, Group B and Group C respectively. The percentage correction achieved was 72.5 ± 14.5% in Group A, 82 ± 6% in Group B and 82 ± 8% in Group C. The difference between percentage correction achieved and the flexibility index was 12.45 ± 8.22, 12.05 ± 1.3 and 15.00 ± 1.21% in Group A, B and C, respectively The percentage loss of correction in Cobb angles at final follow-up in Group A, B and C was 12.5 ± 3.5, 16.5 ± 1. and 12.5 ± 2.5%, respectively. Complications seen in Group A were three cases of wound infection and two cases of implant failure; Group B had a single case of implant failure and Group C had one patient with wound infection and one case with a partial screw pull out. Early surgery and smaller curve corrections appears to be the current trend in the management of scoliosis in DMD. This has been possible due to early curve detection and surgery thus having the advantage of less post-operative respiratory complications and stay in paediatric intensive care. Also, early surgery avoids development of pelvic deformity and extension of instrumentation to the pelvis thereby reducing blood loss. This trend reflects the advent of newer and safer instrumentation systems, advanced techniques in anaesthesia and cord monitoring. Sublaminar instrumentation system group had increased operating times and blood loss compared to both the hybrid and pedicle screw instrumentation systems due to increased bleeding from epidural vessels and pelvic instrumentation. Overall, the three instrumentation constructs appear to provide and maintain an optimal degree of correction at medium to long term follow up but the advantages of lesser blood loss and surgical time without the need for pelvic fixation seem to swing the verdict in favour of the pedicle screw system.

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Section: Discussionmentioning

confidence: 99%

Scoliosis in Duchenne’s muscular dystrophy: a changing trend in surgical management

Arun

Srinivas²,

Mehdian³

2009

Eur Spine J

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“…When pedicle screws are placed accurately, they should be completely contained within the pedicle, whereas hook insertion necessitates canal intrusion of approximately 30% [2]. Also, hooks are more prone to shift during correction maneuvers [8,9]. Another benefit of the more rigid stabilization offered by pedicle screw fixation is the ability to use shorter constructs to achieve deformity correction, thus preserving more motion segments than other techniques and potentially decreasing postoperative back pain [3,16,22].…”

Section: Introductionmentioning

confidence: 99%

Do Intraoperative Radiographs in Scoliosis Surgery Reflect Radiographic Result?

Lehman

Lenke

Helgeson³

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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It is often difficult to predict postoperative radiographic curve magnitude and balance parameters while performing intraoperative correction during scoliosis surgery. We asked whether there was a radiographic correlation between intraoperative long-cassette scoliosis film and postoperative standing radiographs of adolescent idiopathic scoliosis with pedicle screw instrumentation. We retrospectively reviewed 44 patients with adolescent idiopathic scoliosis who underwent posterior instrumentation with pedicle screws. We made preoperative, intraoperative (after instrumentation and correction), and standing postoperative radiographic measurements (eg, curve magnitudes, coronal and sagittal balance, disc angles) and compared those for the intra-and postoperative radiographs. The intraoperative long-cassette scoliosis film correlated with the immediate postoperative standing film for all curve correction and balance parameters. The routine use of a long-cassette intraoperative scoliosis film provides the surgeon with a valuable tool to guide intraoperative decision-making and foreshadows the correction and balance obtained on the immediate postoperative film.

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“…Previous studies have been comprehensive surgeon-reported complication rates [1]; descriptions of particular complications, such as infections [11], superior mesenteric artery syndrome [4,13], etc; complications related to a certain technique, such as thoracoscopic treatment [8,10]; or complications compared between different techniques, such as hooks versus screws [5,6,12]. Our aim was to define a radiographic system of * P values were calculated using an overall chi square test for all treatment groups for existence of a serious radiographic adverse event (p = 0.427) or a radiographic adverse event (p = 0.88); no significant difference was found between the different surgical treatments; OASF = open anterior instrumented spinal fusion; TASF = thoracoscopic anterior instrumented spinal fusion; PSFH = posterior instrumented spinal fusion with an anchor system that utilized hooks or hooks, wires, and screws (hybrid systems); PSFS = posterior instrumented spinal fusion with an anchor system that utilized a majority of pedicle screws.…”

Section: Discussionmentioning

confidence: 99%

Radiographic Classification of Complications of Instrumentation in Adolescent Idiopathic Scoliosis

Flynn¹,

Betz²,

O’Brien³

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Comparative Analysis of Pedicle Screw Versus Hybrid Instrumentation in Posterior Spinal Fusion of Adolescent Idiopathic Scoliosis

Cited by 393 publications

References 25 publications

Scoliosis in Duchenne’s muscular dystrophy: a changing trend in surgical management

Scoliosis in Duchenne’s muscular dystrophy: a changing trend in surgical management

Do Intraoperative Radiographs in Scoliosis Surgery Reflect Radiographic Result?

Radiographic Classification of Complications of Instrumentation in Adolescent Idiopathic Scoliosis

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