One stage correction via the Hi-PoAD technique for the management of severe, stiff, adolescent idiopathic scoliosis curves > 90°

Abstract

Study design Retrospective cohort study. Purpose to assess the efficacy and safety of Hi-PoAD technique in patients with a major thoracic curve > 90°, < 25% of flexibility and deformity spread over more than five vertebral levels. Methods retrospective review of AIS patients with a major thoracic curve (Lenke 1–2–3) > 90°, with < 25% of flexibility and deformity spread over more than five vertebral levels. All were treated via the Hi-PoAD technique. Radiographic and clinical score data were collected pre-operatively, operatively, at 1 year, 2 years and at last follow-up (2 years minimum). Results 19 patients were enrolled. A 65.0% correction rate of the main curve was achieved, from 101.9° to 35.7° (p < 0.001). The AVR reduced from 3.3 to 1.3. The C7PL/CSVL reduced from 1.5 to 0.9 cm (p = 0.013). Trunk Height increased from 31.1 to 37.0 cm (p < 0.001). At the final follow-up no significant changes, except from an improvement in C7PL/CSVL (from 0.9 cm to 0.6 cm; p = 0.017). SRS-22 increased in all patients, from 2.1 to 3.9 at 1 year of follow-up (p < 0.001). 3 patients had a transient drop of MEP and SEP during maneuver and were managed with temporary rods and a second surgery after 5 days. 2 of these 3 cases (66.7%) had a Total-Deformity Angular Ratio (T-DAR) > 25; conversely, among patients who had a one-stage procedure, only 1 (6.2%) had a T-DAR > 25 (p = 0.008). Conclusions The Hi-PoAD technique proved to be a valid alternative for the treatment of severe, rigid AIS involving more than 5 vertebral bodies. Study design Retrospective comparative cohort study. Level of evidence III.

Ponte Osteotomies in the Surgical Treatment of Adolescent Idiopathic Scoliosis: A Systematic Review of the Literature and Meta-Analysis of Comparative Studies

“…Therefore, this result seems to apply only to non-severe, non-stiff, coronal deformities. Conversely, some authors [11,26] adopted multiple asymmetric POs for the management of severe (>90 • ) and stiff (flexibility index < 25%) curves. Unfortunately, these were not comparative studies, so they were not suitable for the present analysis.…”

“…Many authors [10,11] have therefore adopted ancillary procedures such as Ponte osteotomies (POs) in order to restore TK, or at least to optimize the corrective maneuver, trying to avoid the risk of iatrogenic hypokyphosis as much as possible. Ponte osteotomies were first developed in 1987 by Alberto Ponte for the surgical correction of rigid hyperkyphosis [12].…”

Posterior Spinal Fusion Surgery for Neuromuscular Disease Patients with Severe Scoliosis Whose Cobb Angle Was over 100 Degrees

“…Regarding the differences between NMS and adolescent idiopathic scoliosis (AIS), Faldini C. et al demonstrated a good correction rate (65.0%) of the main curve in AIS patients with Cobb angles exceeding 90° using PSF surgery alone [ 25 ]. Additionally, Traversari M. et al reported a mean correction rate of 58.6% for the major curve in severe AIS patients undergoing PSF surgery through a one-stage posterior-only approach, as shown in their systematic review and meta-analysis [ 26 ].…”