Hybrid constructs pedicle screw with apical sublaminar bands versus pedicle screws only for surgical correction of adolescent idiopathic scoliosis

Palmisani, M.; Dema, Eugenio; Cervellati, S.; Palmisani, Rosa

doi:10.1007/s00586-018-5625-x

Cited by 16 publications

(7 citation statements)

References 25 publications

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“…A well inserted, till the vertebral body, pedicle screw has a greater moment arm that permits to apply greater corrective forces with respect to hooks. [1724] These results may be appreciated in our series; in fact, the correction of major curve improved from a mean of 47.46 ± 19.27 in G1 to 57.30 ± 24.96 in G2, when hybrid constructs were used, but better results were achieved with only screw intrumentations.…”

Section: Discussionsupporting

confidence: 50%

Surgical treatment of spinal deformities in Marfan syndrome: Long-term follow-up results using different instrumentations

Palmisani

Dema

Rava

et al. 2019

J Craniovert Jun Spine

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Background:Scoliosis is the most frequent spinal deformity related to Marfan syndrome (MFS). Treatment with a brace is often ineffective, and surgical treatment is very challenging; many instrumentations were used along the years. Our retrospective study has the purpose of identifying the reliability of different devices in three-dimensional correction of the spine deformities in MFS.Materials and Methods:We reviewed retrospectively the records of patients surgically treated, in a single institution between 1999 and 2016, for spinal deformities in MFS. X-rays were reviewed for analyzing the magnitude of the curves in preoperative time (T0), the amount of correction in the immediate after surgery period (T1), and it's stability at follow-up (FU) (T2). The clinical outcomes were also evaluated with the Scoliosis Research Society 24.Results:A total of 21 patients with a mean age at surgery of 16 years met inclusion and exclusion criteria. Four different construct types were identified: hooks with sublaminar wires (G1), hooks and pedicle screws (G2), pedicle screws (G3), and pedicle screws with sublaminar wires (G4). The mean FU time was 8 years. The average major scoliosis curve had a mean value of 63.48° at T0 and was corrected to 28.81° at T2. Furthermore, minor curve, thoracic lordosis, and lumbar kyphosis (when associated to scoliosis) were also corrected. Student t-test showed significative differences (P < 0.05) for all curves between T0–T1 and T0–T2 while between T1 and T2, no differences were found. We also evaluated separately the results of each instrumentation, and G3 obtained the best performances.Conclusions:Our results shows that screws may guarantee a better correction of the deformities.Level of Evidence:III

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Section: Discussionsupporting

confidence: 50%

Surgical treatment of spinal deformities in Marfan syndrome: Long-term follow-up results using different instrumentations

Palmisani

Dema

Rava

et al. 2019

J Craniovert Jun Spine

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“…Qi reported the total perforation rate of 7.8% in 306 TP screws from 21 AIS patients using a landmark determined by CT scan [ 25 ]. In the literature, the reported intraoperative blood loss for AIS surgery with pedicle screw instrumentation ranged from 500 to 1212 ml [ 27 – 32 ] and the mean operation time ranged from 146 to 378 min [ 28 , 32 – 34 ]. Both the average blood loss and average operation time of our cases were comparable with previous studies.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of thoracic pedicle screw placement in adolescent idiopathic scoliosis patients using the entry point identified by new landmarks: a computed tomography study

Jiang

Qiu

et al. 2022

BMC Surg

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Background Although thoracic pedicle (TP) screw has gained increasingly popularity in the surgical treatment of adolescent idiopathic scoliosis (AIS) patients, questions remain about the accurate selection of entry point for TP screw placement in these patient. The main objective of the present study was to evaluate the accuracy of TP screw placement in AIS patients using the entry point identified by new landmarks. Methods Thirty-four thoracic AIS patients treated with posterior TP screw instrumentation were included. All these TP screws were inserted through the entry point identified by new landmarks with free-hand technique. Postoperative CT scans were obtained to evaluate the screw position. The perforations of the pedicle were classified as grade 0 (no perforation), grade 1 (≤ 2 mm), grade 2 (2.1–4 mm), grade 3 (4.1–6 mm) and grade 4 (6.1–8.0 mm). Screws in grade 0, displaced either medially or anteriorly in grade 1 and displaced laterally in grades 1 to 2 were considered acceptable. Results Of the 495 TP screws inserted, 34 (6.9%) screws were displaced with 7 screws (1.4%) displaced medially, 20 screws (4.1%) displaced laterally and 7 screws (1.4%) displaced anteriorly (P < 0.05). Among the 34 displaced screws, 11 screws (32.4%) were considered as grade 1, 14 screws (38.2%) as grade 2 and 9 screws (29.4%) as grade 3 (P < 0.05). The overall rate of acceptable screws was 97.8%. No screw-related complication was noted. Conclusion Our new method for selecting the entry point of TP screw in AIS patients is convenient and can achieve high accuracy of screw placement, which is worthy of being widely popularized.

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“…Our data suggested that 15 (26.3%) patients, presenting an APEX±1 pedicle on the concave side, would sustain a fracture if a screw for the thoracic spine was inserted. For patients in whom the PS could not be inserted at the concave side of APEX±1, we might consider using hook or sublayer wiring [ 30 , 31 ]. Convex side correction with PS inserted into the convex side might also be considered a useful correction method [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Three-dimensional morphological analysis of the thoracic pedicle and related radiographic factors in adolescent idiopathic scoliosis

Sato

Nojiri

Okuda

et al. 2022

BMC Musculoskelet Disord

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Background This study aimed to investigate the laterality of the pedicle morphology at the apical vertebra (AV) level and identify the radiographic factors associated with the laterality ratio of the pedicle morphology at the AV level in patients with adolescent idiopathic scoliosis (AIS). Methods Overall, 684 pedicles in 57 AIS patients aged 10–20 years, who underwent preoperative computed tomography (CT) and had Lenke type 1 or 2 with right convex main thoracic curves (MTC), were evaluated. Pedicle diameters of the MTC were assessed. We defined and compared the region containing two vertebrae adjacent to the AV (APEX±1) and the region containing two vertebrae adjacent to the neutral vertebra. We analyzed the pedicle diameter and laterality ratio of APEX±1 and performed multiple linear regression analysis to identify the radiographic factors associated with the laterality of the pedicle diameter. Results On the concave side of APEX±1, the pedicles of 15 patients (26.3%) did not accept a 4-mm-diameter pedicle screw (PS), even with 25% cortical bone width expansion. Laterality ratio differences in the pedicle diameters of the cortical bone width in APEX±1 were large in patients with more proximal AV level (p < 0.001) and smaller apical vertebral rotation (AVR) (p = 0.029). Conclusions Preoperative planning to accurately select and insert the PS in AIS should be based on the anatomical limitations in APEX±1, AV level, and AVR degree. In APEX±1, the correlation between AVR and the laterality ratio of the pedicle diameter may be useful for pathoetiological interpretation of the AIS deformity.

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Hybrid constructs pedicle screw with apical sublaminar bands versus pedicle screws only for surgical correction of adolescent idiopathic scoliosis

Cited by 16 publications

References 25 publications

Surgical treatment of spinal deformities in Marfan syndrome: Long-term follow-up results using different instrumentations

Surgical treatment of spinal deformities in Marfan syndrome: Long-term follow-up results using different instrumentations

Accuracy of thoracic pedicle screw placement in adolescent idiopathic scoliosis patients using the entry point identified by new landmarks: a computed tomography study

Three-dimensional morphological analysis of the thoracic pedicle and related radiographic factors in adolescent idiopathic scoliosis

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