New Anterior Instrumentation for the Management of Thoracolumbar and Lumbar Scoliosis

Kaneda, Kiyoshi; Shono, Yasuhiro; Satoh, Shun; Abumi, Kuniyoshi

doi:10.1097/00007632-199605150-00021

Cited by 177 publications

(113 citation statements)

References 25 publications

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“…The proponents of anterior instrumentation have report several strategic differences. The choice of instrumentation can differ in terms of its elasticity or rigidity and can consist of either one [5,8,16,39] or two rods [1,7,13,17,34], possibly associated with cages [7,37]. The stiffness of the two-rod construct decreases the risk of hardware breakage.…”

Section: Surgical Treatmentmentioning

confidence: 99%

“…instrumentation set off a new wave of enthusiasm for its potential use in posterior instrumentation [36], and this was accompanied by a loss of interest in the anterior approach, which we criticized in a somewhat provocative article [2]. Several surgeons then improved the anterior constructs to make them stiffer and more efficient [13,14,16,17,33,37]. But almost simultaneously, pedicular screws were developed: the controversy was fueled anew [26] and is still raging today, for both objective and subjective reasons.…”

Section: S158mentioning

confidence: 99%

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Anterior instrumentation (dual screws single rod system) for the surgical treatment of idiopathic scoliosis in the lumbar area: a prospective study on 33 adolescents and young adults, based on a new system of classification

Bergoin¹

2012

Eur Spine J

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Objectives/purpose The choice of anterior instrumentation in the treatment of lumbar scoliosis in adolescents and young adults is not a new topic for the authors. The first results achieved using the Dwyer surgical modality were reported by one of the authors followed by the results achieved using Zielke (VDS) instrumentation. Today, new techniques and new instrumentations have been developed that challenge the instrumentation choices. Here we describe how the new system of classification of scoliotic curves we developed has been used as a basis for treating idiopathic scoliosis in lumbar area in adolescents and young adults using an anterior approach. Materials A prospective study was carried out between 1998 and 2010 at two hospital centers on 33 adolescents and young adult with idiopathic lumbar scoliosis involving curves of three kinds, on whom surgical treatment was performed using a single solid rod. Topography of curves: our system of classification includes curves corresponding to the following three type of scoliosis: Type K I: double thoracic and lumbar curves (lumbar predominant) scoliosis (17 cases) mean age 16 years all female patients. Mean Cobb angle of lumbar curve 41°. Mean Cobb angle of thoracic curve 28°. The lumbar curve was left hand convex in 15 cases and right hand convex in 2 cases. Horizontal tilting of L4 mean value 22°. C7 offset mean value 3 cm. Type K IV A: unbalanced thoracolumbar scoliosis (13 cases) mean age 17 years, ten female patients and three male patients. Mean Cobb angle of thoracolumbar curve 39°. The thoracolumbar curve was left hand convex 4 times and right hand convex 9 times. Horizontal tilting of L4 mean value 18°. C 7 offset mean value 2.5 cm. Type K VI A: real lumbar (three cases). Age: 17, 15 and 13 years; all female patients. Cobb angle of the lumbar curve 66°, 29°a nd 70°(all LH convex). Horizontal tilting of L4: 40°, 20°a nd 46°. C 7 offset: 7 cm, 1 cm and 4 cm. 123Eur Spine J (2013) 22 (Suppl 2):S149-S163 DOI 10.1007/s00586-012-2343-7 failure: there were three cases of screw breakage, all occurred on the lowest implant. Revision surgery was undertaken in both cases, only the last plate needed to be replaced and the rod could be kept without any other modification of the construct. In both cases, fusion has been achieved without any loss of correction. The mean loss of correction of the main curve was 2.5°for the three series. Conclusions Anterior instrumentation of lumbar idiopathic scoliosis gives highly satisfactory morphological and functional results, since the lumbar musculature is spared and the instrumentation placed at the apex of the curvature has selective effects. Despite our preference and that of other surgeons throughout the world for anterior instrumentation, we are still a minority in comparison with the users of posterior instrumentation. There are several reasons for this reticence, including surgeons' training and ideas about pedicular screw fixation, but the main reason has been the lack of a sufficiently exact system of classificat...

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Section: Surgical Treatmentmentioning

confidence: 99%

Section: S158mentioning

confidence: 99%

Anterior instrumentation (dual screws single rod system) for the surgical treatment of idiopathic scoliosis in the lumbar area: a prospective study on 33 adolescents and young adults, based on a new system of classification

Bergoin¹

2012

Eur Spine J

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“…Kaneda et al [5] reported postoperative disc wedging in patients with TL/L AIS following anterior spinal fusion with Kaneda dual rod instrumentation. The average discwedging angle was 6.6°in patients who underwent a short fusion and 3°in patients where the LEV was included in the fusion at 2-4 years postoperatively.…”

Section: Discussionmentioning

confidence: 99%

Radiographic evaluation of selective anterior thoracolumbar or lumbar fusion for adolescent idiopathic scoliosis

Wang

Zeng

et al. 2008

Eur Spine J

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According to Lenke classification of adolescent idiopathic scoliosis (AIS), patients with type 5 curve in which the structural major curve is thoracolumbar or lumbar curve with nonstructural proximal thoracic and main thoracic curves, could be surgically treated with selective anterior thoracolumbar or lumbar (TL/L) fusion. This study retrospectively analyzed the radiographies of selective anterior TL/L fusion in 35 cases of AIS with Lenke type 5 curve. Segmental fixation with a single rigid rod through anterior thoracoabdominal approach was applied in all patients. Measurements of scoliosis curve in preoperative, immediate postoperative and follow-up radiographies were analyzed. The average follow up time was 36 months (24-42 months). The average preoperative Cobb angle of the TL/L curve was 45.6°and improved into 9.7°immediate postoperatively, with 79.7% curve correction. In addition, the minor thoracic curve decreased from 29.7°preopera-tively to 17.6°postoperatively, with a spontaneous correction of 41.5%. During the follow-up, a loss of 4.6°c orrection was found and the average Cobb angle of TL/L increased to 14.4°. Also, the minor thoracic curve increased to average 20.1°with a loss of 2.4°correction. Trunk shift deteriorated slightly immediate postoperatively and improved at the follow-up. The lowest instrumented vertebra (LIV) tilt was improved significantly and maintained its results at the follow-up. During the follow-up, the coronal disc angle immediately above the upper instrumented vertebra (UIVDA) and below the LIV (LIVDA) aggravated, while the sagittal contours of T5-T12 and T10-L2 were well maintained. The lumbar lordosis of L1-S1 and the sagittal Cobb angle of the instrumented segments were reduced slightly postoperatively and at the follow-up. There were no major complications or pseudarthrosis. The outcomes of this study show that selective anterior thoracolumbar or lumbar fusion with solid rod instrumentation is effective for surgical correction of AIS with Lenke type 5 curve. The TL/L curve, minor thoracic curve, and LIV title can be improved significantly, with good maintenance of sagittal contour. However, the UIVDA and LIVDA aggravate postoperatively when the trunk rebalances itself during follow-up. The degeneration of LIV disc warrants longer-term follow-up.

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“…However, toggling and pullout of the proximal screw was observed with this system. Other systems such as the Kaneda system have used two rods and therefore two screws per vertebra, in an attempt to prevent screw pullout and increase stability [6]. Such systems are, however, indicated for thoracolumbar or lumbar curve and cannot be applied to the upper thoracic vertebrae, which are too small to accommodate two screws.…”

Section: Discussionmentioning

confidence: 99%

The suprapedicle claw construct in anterior scoliosis surgery

Arlet¹,

Shilt²,

Ouellet³

2005

Eur Spine J

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New Anterior Instrumentation for the Management of Thoracolumbar and Lumbar Scoliosis

Cited by 177 publications

References 25 publications

Anterior instrumentation (dual screws single rod system) for the surgical treatment of idiopathic scoliosis in the lumbar area: a prospective study on 33 adolescents and young adults, based on a new system of classification

Anterior instrumentation (dual screws single rod system) for the surgical treatment of idiopathic scoliosis in the lumbar area: a prospective study on 33 adolescents and young adults, based on a new system of classification

Radiographic evaluation of selective anterior thoracolumbar or lumbar fusion for adolescent idiopathic scoliosis

The suprapedicle claw construct in anterior scoliosis surgery

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