Correction of Adolescent Idiopathic Scoliosis Using Thoracic Pedicle Screw Fixation Versus Hook Constructs

Storer, Stephen; Vitale, Michael G.; Hyman, Joshua E.; Lee, Francis Y.; Choe, Julie C; Roye, David P.

doi:10.1097/01.mph.0000165134.38120.87

Cited by 92 publications

(35 citation statements)

References 21 publications

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“…The radiographic measurements in this study are comparable to those previously reported (Table 6) [12][13][14][15][16][17]. Major curve correction in the coronal plane was 73 % in the screw group and 56.9 % in the hook group.…”

Section: Discussionsupporting

confidence: 89%

Screws versus hooks: Implant cost and deformity correction in adolescent idiopathic scoliosis

Jaquith

Chase

Flinn

et al. 2012

Journal of Children's Orthopaedics

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Objective To compare the costs of two spinal implantshook and hybrid constructs and pedicle screw constructsin posterior spinal fusion for adolescent idiopathic scoliosis (AIS) as they relate to intraoperative deformity correction. Study design and method This retrospective study examined 50 patients with AIS who were treated with posterior spinal fusion using segmental hook-hybrid constructs (23) or pedicle screws (27). Radiographic parameters measured on immediate preoperative and initial standing postoperative scoliosis films were the coronal Cobb angles of the upper thoracic, middle thoracic, lumbar, and instrumented curves; global coronal and sagittal balance; thoracic kyphosis; lumbar lordosis; and type and number of implants used. Current implant cost data were obtained from three major spinal implant manufacturers to determine the total cost of the constructs, cost per degree of correction, cost per level fused, and cost per degree of correction of the major curve. Results After surgery, the average percentage of correction for the middle thoracic curve or major curve was 57 % in the hook-hybrid group compared to 73 % in the pedicle screw group (P \ 0.001). The average amount of correction of the major curve was 31.1°in the hook-hybrid group compared to 42.7°in the pedicle screw group (P \ 0.001). The average number of fused levels was 10.7 in the hookhybrid group compared to 12.2 in the pedicle screw group (P \ 0.001). The average number of implants was 14.8 in the hook-hybrid group compared to 23.3 in the pedicle screw group (P \ 0.001). The average total cost of implants was $11,248 in the hook-hybrid group compared to $22,826 in the pedicle screw group (P \ 0.001), and the average cost per fused level was $1,058 in the hook-hybrid group compared to $1,878 in the pedicle screw group (P \ 0.001). The average cost per degree of correction of the major curve was $415 in the hook-hybrid group compared to $559 in the pedicle screw group (P = 0.0014). The global coronal balance, global sagittal balance, thoracic kyphosis, and lumbar lordosis did not differ significantly between the two groups. Conclusion Pedicle screw instrumentation was shown to be more expensive overall, per fused level, and per degree of correction. Also, more implants were used and more levels were fused in the pedicle screw group than in the hook-hybrid group. Pedicle screws showed a statistically significantly greater percentage of correction of the major curve. Physicians must evaluate each patient individually and determine if the increased percentage of correction warrants the increased cost for pedicle screw constructs.

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Section: Discussionsupporting

confidence: 89%

Screws versus hooks: Implant cost and deformity correction in adolescent idiopathic scoliosis

Jaquith

Chase

Flinn

et al. 2012

Journal of Children's Orthopaedics

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“…In contrast, there are those who report similar major curve correction with similar loss of correction over time, similar fusion lengths, and similar SRS scores, with lower implant costs. 5,44,45 This similarity has been established especially when sublaminar wires are added in the hybrid construct. 45 These have been reported to be at least as safe and effective as other instrumentations.…”

Section: Discussionmentioning

confidence: 94%

Does Wide Posterior Multiple Level Release Improve the Correction of Adolescent Idiopathic Scoliosis Curves?

Pizones

Izquierdo

Sánchez-Mariscal

et al. 2010

Journal of Spinal Disorders &Amp; Techniques

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“…Several authors have developed mathematical expressions in order to measure the morphology of scoliotic spines in three dimensions as well as the rotation of vertebrae [1][2][3]. Since then, correction of scoliosis deformity in frontal, sagittal and axial planes has been widely studied [4][5][6][7][8][9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Influence of implant rod curvature on sagittal correction of scoliosis deformity

et al. 2014

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PURPOSE:To analyze the changes of implant rod angle of curvature during surgery and establish its influence on sagittal correction of scoliosis deformity. STUDY DESIGN:A retrospective analysis of the preoperative and postoperative implant rod geometry and angle of curvature was conducted.PATIENT SAMPLE: Twenty adolescent idiopathic scoliosis patients underwent surgical operation. Average age at the time of operation was 14 years. OUTCOME MEASURES:The preoperative and postoperative implant rod angle of curvature expressed in degrees was obtained for each patient. METHODS:Two implant rods were attached to the concave and convex side of the spinal deformity. The preoperative implant rod geometry was measured before surgical implantation.The postoperative implant rod geometry after surgery was measured by Computed Tomography scanner. The implant rod angle of curvature at the sagittal plane was obtained from the implant rod geometry. The angle of curvature between the implant rod extreme ends was measured before implantation and after surgery. The sagittal curvature between the corresponding spinal levels of healthy adolescents obtained by previous studies was compared to the implant rod angle of curvature to evaluate the sagittal curve correction. The difference between the postoperative implant rod angle of curvature and normal spine sagittal curvature of the corresponding instrumented level was used to evaluate over or under correction of the sagittal deformity.Page | 3 RESULTS:The implant rods at the concave side of deformity of all patients were significantly deformed after surgery. The average degree of rod deformation Δθ at the concave and convex side was 15.8 deg. and 1.6 deg., respectively. The average preoperative and postoperative implant rod angle of curvature at the concave side was 33.6 deg. and 17.8 degrees, respectively. The average preoperative and postoperative implant rod angle of curvature at the convex side was 25.5 degrees and 23.9 degrees, respectively. A significant relationship was found between the degree of rod deformation and preoperative implant rod angle of curvature (r = 0.60, p < 0.005). The implant rods at the convex side of all patients did not have significant deformation. The results indicate that the postoperative sagittal outcome could be predicted from the initial rod shape. CONCLUSIONS:Changes in implant rod angle of curvature may lead to over or under correction of the sagittal curve. Rod deformation at the concave side suggests that corrective forces acting on that side are higher than the convex side.

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Correction of Adolescent Idiopathic Scoliosis Using Thoracic Pedicle Screw Fixation Versus Hook Constructs

Cited by 92 publications

References 21 publications

Screws versus hooks: Implant cost and deformity correction in adolescent idiopathic scoliosis

Screws versus hooks: Implant cost and deformity correction in adolescent idiopathic scoliosis

Does Wide Posterior Multiple Level Release Improve the Correction of Adolescent Idiopathic Scoliosis Curves?

Influence of implant rod curvature on sagittal correction of scoliosis deformity

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