Comparison of Surgical Treatment in Lenke 5C Adolescent Idiopathic Scoliosis: Anterior Dual Rod Versus Posterior Pedicle Fixation Surgery

Geck, Matthew J.; Rinella, Anthony; Hawthorne, Dana; Macagno, Angel; Koester, Linda A.; Sides, Brenda; Bridwell, Keith H.; Lenke, Lawrence G.; Shufflebarger, Harry

doi:10.1097/brs.0b013e3181a3c777

Cited by 107 publications

(85 citation statements)

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“…The choice of UIV and LIV in Lenke 5C patients has been a subject of debate in the past decade [18,19]. Although rare general algorithms have been proposed for reference, spine surgeons usually select the UIV and LIV prior to surgery based on experiences and preferences.…”

Section: Discussionmentioning

confidence: 99%

Role of the upper and lowest instrumented vertebrae in predicting the postoperative coronal balance in Lenke 5C patients after selective posterior fusion

et al. 2013

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Purpose To investigate which pre-and postoperative radiographic parameters are significantly correlated with the immediate postoperative coronal balance (CB) in Lenke 5C AIS patients, and to identify any radiographic parameter that is correlated with the ultimate CB at a minimum follow-up of 2 years. Methods Forty Lenke 5C AIS patients were recruited in the current study. Preoperative, immediate postoperative, and the latest follow-up radiographs were reviewed measuring various radiographic parameters related to UIV and LIV. The correlations between different parameters and CB were then studied. Results The average follow-up time was 35.2 months. Correlation analysis showed that the following radiographic parameters significantly associated with the immediate postoperative CB in Lenke 5C patients: preoperative CB (r = 0.66, p \ 0.01), preoperative UIV translation (r = 0.61, p \ 0.01), preoperative LIV tilt (r = 0.61, p \ 0.01), postoperative UIV translation (r = 0.51, p \ 0.05), and postoperative LIV tilt (r = 0.50, p \ 0.05). At the last follow-up, only the final UIV tilt was inversely correlated with the ultimate CB (r = -0.58, p \ 0.05). Seven patients presented with coronal imbalance immediately after surgery. However, only one of the seven patients presented with coronal imbalance at the last follow-up, and

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Section: Discussionmentioning

confidence: 99%

Role of the upper and lowest instrumented vertebrae in predicting the postoperative coronal balance in Lenke 5C patients after selective posterior fusion

et al. 2013

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“…Tis et al [6] noted a mean kyphosis increase of 15°in patients with Risser sign of \1. On the other hand, the sagittal profile of the lumbar spine has been one of the weak points of anterior spinal instrumentation, which has a limited ability to correct lumbar lordosis even with interbody devices [5,7]. To minimize the kyphosing effect, interbody devices or other structural grafts should always be used when instrumenting below the L1 level.…”

Section: Outcomes After Anterior Open Spinal Instrumentation For Aismentioning

confidence: 99%

“…Geck et al [5] compared the outcomes of anterior dual rod versus posterior pedicle screw instrumentation for 31 matched pairs of patients with Lenke 5C AIS. In terms of major curve correction (84 vs. 67 %), loss of correction (3.4 vs. 9.4 %), ability to correct lumbar lordosis (17°vs.…”

Section: Outcomes After Anterior Open Spinal Instrumentation For Aismentioning

confidence: 99%

“…Beginning in the 2000s, excellent outcomes were also reported for thoracoscopic anterior spinal fusion and instrumentation, but the long learning curve, unfamiliarity with thoracoscopic surgery, and longer operative time have restricted its largescale use among orthopaedic surgeons. During this same period, posterior pedicle screw instrumentation for both thoracic and thoracolumbar idiopathic scoliosis with posterior Ponte osteotomies [5] gained large popularity due to a lower morbidity and better pulmonary function outcomes compared to anterior surgery, as well as similar radiographic outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Anterior surgery for adolescent idiopathic scoliosis

Helenius

2013

Journal of Children's Orthopaedics

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Anterior open scoliosis surgery using the dual rod system is a safe and rather effective procedure for the correction of scoliosis (50-60 %). Thoracic hypokyphosis and rib hump correction with open anterior rather than posterior instrumentation appear to be the better approaches, although the latter is somewhat controversial with current posterior vertebral column derotation devices. In patients with Risser grade 0, hyperkyphosis and adding-on may occur with anterior thoracic spine instrumentation. Anterior thoracoscopic instrumentation provides a similar correction (65 %) with good cosmetic outcomes, but it is associated with a rather high risk of instrumentation (pullout, pseudoarthrosis) and pulmonary complications. Approximately 80 % of patients with adolescent idiopathic scoliosis (AIS) curves of[70°have restrictive lung disease or smaller than normal lung volumes. AIS patients undergoing anterior thoracotomy or anteroposterior surgery will demonstrate a significant decrease in percentage of predicted lung volumes during follow-up. The thoracoabdominal approach and thoracoscopic approach without thoracoplasty do not produce similar changes in detrimental lung volume. In patients with severe AIS ([90°), posterior-only surgery with TPS provides similar radiographic correction of the deformity (44 %) with better pulmonary function outcomes than anteroposterior surgery. Vascular spinal cord malfunction after segmental vessel ligation during anterior scoliosis surgery has been reported. Based on the current literature, the main indication for open anterior scoliosis instrumentation is Lenke 5C thoracolumbar or lumbar AIS curve with anterior instrumentation typically between T11 and L3.

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“…The risk factors for coronal decompensation have been described thoroughly in the literature [22,[32][33][34], including improper selection of the distal fusion level [32] and the instrumentation pattern [34], hypercorrection of the main curve [22], use of over distraction [34], great growth potentiality [32], and so on. However, most of the risk factors were identified for King 2 curve (Lenke 1C, Lenke 3); risk factors for decompensation in patients with main TL/L curve are poorly documented.…”

Section: Pelvic Axial Rotation (Par)mentioning

confidence: 99%

Preoperative pelvic axial rotation: a possible predictor for postoperative coronal decompensation in thoracolumbar/lumbar adolescent idiopathic scoliosis

et al. 2013

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Background The pelvis as the biomechanical foundation of spine, plays an important role in the balance of the stance and gait through the multi-link spinal-pelvic system. If the pelvic axial rotation (PAR) exists in adolescent idiopathic scoliosis (AIS) patients, it should theoretically have some effects on the body balance. Purpose To explore the probable effects of preoperative PAR on the spinal balance in coronal plane in AIS patients with main thoracolumbar/lumbar (TL/L) curve after posterior spinal instrumentation. Methods Thirty-eight AIS patients (age: 15 ± 1.5 years) with main TL/L curve (51°± 6.2°) were recruited retrospectively into this study. The mean follow-up period was 27 months (24-36 months). Standing full spine posteroanterior radiographs were taken preoperatively, 3 month and 1 year postoperatively, and at last follow-up. The convex/concave ratio (CV/CC ratio) of the anterior superior iliac spine laterally and the inferior ilium at the sacroiliac joint medially was measured on posteroanterior radiographs. According to the preoperative CV/CC ratios, the patients were divided into two groups: normal group (N-group: 0.95 B CV/CC B 1.05); and the asymmetrical group (A-group: CV/CC \ 0.95, or [1.05). Results In all the patients, the 3-month-postoperative CV/ CC ratio (1.026 ± 0.087) was significantly different from the preoperative CV/CC ratio (0.969 ± 0.095, P \ 0.001), indicating that the pelvis had rotated in the opposite direction of the corrective derotation load applied to the TL/L spine after surgery. No significant change was found in the CV/CC ratio from 3-month-postoperative to the last follow-up (1.013 ± 0.103, P [ 0.05). There was no significant difference in the demographic, phenotypic, and treatment variables between the N-(n = 16) and A-groups (n = 22) (P [ 0.05). However, more coronal decompensation occurred in the A-group after surgery (36.4 vs. 0.0 %, P = 0.013): two patients having trunk translation, three having lower instrumented vertebra (LIV) translation, and one having LIV tilt; meanwhile, one patient having both LIV translation and LIV tilt, and one having both trunk translation and LIV tilt. Conclusions The present study confirmed the existence of PAR in AIS patients, and indicated that the pelvis would experience an active rebalancing in the transverse plane within 3 months after spinal correction, and since then, its position would remain stable. Moreover, TL/L-AIS patients with preoperative asymmetrical PAR probably had greater risk of coronal decompensation postoperatively.

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Comparison of Surgical Treatment in Lenke 5C Adolescent Idiopathic Scoliosis: Anterior Dual Rod Versus Posterior Pedicle Fixation Surgery

Cited by 107 publications

References 20 publications

Role of the upper and lowest instrumented vertebrae in predicting the postoperative coronal balance in Lenke 5C patients after selective posterior fusion

Role of the upper and lowest instrumented vertebrae in predicting the postoperative coronal balance in Lenke 5C patients after selective posterior fusion

Anterior surgery for adolescent idiopathic scoliosis

Preoperative pelvic axial rotation: a possible predictor for postoperative coronal decompensation in thoracolumbar/lumbar adolescent idiopathic scoliosis

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