Primary thoracoplasty and pedicle screw instrumentation in thoracic idiopathic scoliosis

The expectations of both the patient and surgeon have been greatly revised in the last 10 years with the introduction of pedicle screws (PS) in spinal surgery. In this study, we have retrospectively evaluated and compared the results of PS instrumentation and the Hybrid System (HS), the latter consists of pedicle screws, sublaminar wire and hooks. The mean follow-up period was 60.1 months (range: 49-94 months) for the patients of the HS group and 29.3 months (range: 24-35 months) for those of the PS group. In the HS group, pedicle screws were used at the thoracolumbar junction and lumbar vertebra, the bilateral pediculotransverse claw hook configuration was used at the cranial end of the instrumentation, sublaminar wire was used on the concave side of the apical region and the compressive hook was used on the convex side. In the PS group, PS were used on the concave sides at all levels and on the convex side of the cranial and caudal end of instrumentation, in the transition zone and at the apex. The two groups were comparable for variables such as mean age, preoperative Cobb angle, thoracic kyphosis angle, lordosis angle, coronal balance, flexibility of the curve, apical vertebra rotation (AVR), apical vertebra rotation (AVT) and the number of vertebrae included in the fusion (p>0.05). The parameters of values of correction, ratio of correction loss, AV derotation, AVT correction ratio, amount of blood loss, operation time, postoperative global coronal and sagittal balance, thoracic kyphosis angle and lumbar lordosis angle were measured at the last follow-up and used for comparing the HS and PS groups. There was no statistically significant difference between the groups for correction ratio, postoperative coronal balance, postoperative thoracic kyphosis and lumbar lordosis angle, operation time, amount of blood loss and number of fixation points (p>0.05) The difference for the ratio of correction loss, AV derotation angle and the AVT correction ratio at the last follow-up visit and for the total follow-up period between the groups was found to be statistically significant (p<0.05). Although it is possible to obtain a similar amount of correction by either instrumentation system, the loss of correction seems to be lower with the more rigid PS construction. The PS system also has a stronger effect on vertebral bodies, thereby providing better AV de-rotation. There was no significant difference (p>0.05) between the groups in terms of correction rate, postoperative coronal and sagittal balance, operation time, blood loss and number of fixation points. This may indicate that anchor points are more important than the use -or not -of screws. Correction durability and AV de-rotation was better with PS instrumentation, while AVT was better corrected by HS instrumentation (p<0.05). We propose that the reason for the better correction of AVT with HS instrumentation is the forceful translation offered by the sublaminar wire at the apical region, while the reason for the better correction durability of the PS instr...

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“…Min et al [13] reported a 68% correction in Cobb angle and a 54% correction in AVR in his PS group of patients.…”

Section: Discussionmentioning

confidence: 89%

Comparative analysis of pedicle screw versus hybrid instrumentation in adolescent idiopathic scoliosis surgery

Karatoprak

Unay²,

Tezer

et al. 2007

International Orthopaedics (SICO

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“…Existing reports on the surgical correction of scoliosis mostly deal with the instrumentation of the spine using hooks and wires or hybrid constructs with pedicle screws in lumbar region. The use of pedicle screw constructs in thoracic spine has recently become established in the treatment of idiopathic scoliosis [5,26,32]. To date there is no report about the use of pedicle-screw-alone constructs in the treatment of scoliosis in patients with DMD.…”

Section: Introductionmentioning

confidence: 99%

Scoliosis correction with pedicle screws in Duchenne muscular dystrophy

et al. 2007

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This report describes the spinal fixation with pedicle-screw-alone constructs for the posterior correction of scoliosis in patients suffering from Duchene muscular dystrophy (DMD). Twenty consecutive patients were prospectively followed up for an average of 5.2 years (min 2 years). All patients were instrumented from T3/T4 to the pelvis. Pelvic fixation was done with iliac screws similar to Galveston technique. The combination of L5 pedicle screws and iliac screws provided a stable caudal foundation. An average of 16 pedicle screws was used per patient. The mean total blood loss was 3.7 l, stay at the intensive care unit was 77 h and hospital stay was 19 days. Rigid stabilisation allowed immediate mobilisation of the patient in the wheel chair. Cobb angle improved 77% from 44°to 10°, pelvic tilt improved 65% from 14°to 3°. Lumbar lordosis improved significantly from 20°to 49°, thoracic kyphosis remained unchanged. No problems related to iliac fixation, no pseudarthrosis or implant failures were observed. The average percentage of predicted forced vital capacity (%FVC) of the patients was 55% (22-94%) preoperatively and decreased to 44% at the last follow-up. There were no pulmonary complications. One patient with a known cardiomyopathy died intraoperatively due to a sudden cardiac arrest. The rigid primary stability with pedicle screws allowed early mobilisation of the patients, which helped to avoid pulmonary complications.

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“…The Cobb angle correction of the instrumented thoracic curves was less than the result from the posterior approach with segmental pedicle screw fixation [16] but present results from anterior approach were superior in correction of vertebral rotation and improvement of clinical rib hump. There was a good spontaneous correction 33.9% of the non-instrumented lumbar curves in our series which was less than in the series of Brodner et al [15], the reason of which may be that a third of the patients in our series had a lumbar C modifier.…”

Section: Discussionmentioning

confidence: 52%

“…The subjective results of SRS-24 questionnaire showed that the patients were highly satisfied with the cosmetic appearance. The results were better than those from the posterior series where correction was done with pedicle crew instrumentation and also where thoracoplasty was performed additionally [16]. The improvement of rotational deformity of more than 70% was also superior to posterior techniques [16].…”

Section: Discussionmentioning

confidence: 84%

“…The results were better than those from the posterior series where correction was done with pedicle crew instrumentation and also where thoracoplasty was performed additionally [16]. The improvement of rotational deformity of more than 70% was also superior to posterior techniques [16]. This contributed to the 54% improvement of clinical rib hump, which together with a favourable scar produced better cosmetic results.…”

Section: Discussionmentioning

confidence: 86%

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Anterior short correction in thoracic adolescent idiopathic scoliosis with mini-open thoracotomy approach: prospective clinical, radiological and pulmonary function results

et al. 2012

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Introduction This is a prospective study of adolescent patients in whom idiopathic thoracic scoliosis was corrected by short anterior fusion through a mini-open thoracotomy approach. Clinical, radiological and pulmonary function results of minimal 2-year (2-6) follow-up are presented. Materials and methods Consecutive 62 patients with Lenke 1 and 2 curves, having main thoracic scoliosis of up to 75°, were prospectively included. The shoulder imbalance in Lenke 2 patients was less than 20 mm. Thoracic scoliosis was corrected by short anterior fusion. The thoracic spine was exposed by an 8-cm mini-open thoracotomy incision. The operation technique and choosing of fusion levels are thoroughly described. Complete 360°discectomies and convex side vertebral endplates osteotomies are essential for deformity corrections with short fusions. Single-rod 5.5-mm titanium implants were used. The age at the time of operation was mean 15.2 years; 56 patients had a single thoracic curve and 6 patients had a double thoracic curve. There were almost equal numbers of patients with lumbar modifier A, B or C. The average length of fusion was 5.5 (4-7) vertebrae. The average length of fusion was 3.5 (2-6) vertebrae shorter than the average curve length. Results The instrumented thoracic curves improved by 58.3% at 6 weeks and 56.3% at the last follow-up. Apex thoracic vertebral rotation improved by 73.78% at 6 weeks and 76.24% at the last follow-up. The non-instrumented upper thoracic curve improved by 25% in double thoracic scoliosis, where the mid-thoracic curve was selectively fused, and the non-instrumented lumbar curves improved by 33.9% at the last follow-up. The radiological changes from 6 weeks to the last follow-up were statistically not significant. The clinical rib hump improved by 54% at the last follow-up. There were no significant changes in the pulmonary function. FVC% was 81.04% preoperatively, 76.41% at 6 months and 80.38% at the 2-year follow-up. The results of SRS 24 questionnaire improved from a total of 61.40 points preoperatively to 100.50 points at 6 months and 98.62 points at the 2-year follow-up. There were no neurological or thoracotomy related complications, no pseudarthrosis, no implant pullout or breakage. Conclusion A good deformity correction without loss of correction or adding on, a good cosmetic result and good patient's satisfaction were achieved through shorter than end-to-end thoracic fusions. The radiological residual deformity is acceptable. Anterior correction of thoracic scoliosis with a short spinal fusion is recommended to keep the large part of the spine mobile. A very short fusion, small thoracotomy incision, low-profile implants and complete closure of parietal pleura are keys to prevent reduction in postoperative lung function.

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Primary thoracoplasty and pedicle screw instrumentation in thoracic idiopathic scoliosis

Cited by 55 publications

References 19 publications

Comparative analysis of pedicle screw versus hybrid instrumentation in adolescent idiopathic scoliosis surgery

Comparative analysis of pedicle screw versus hybrid instrumentation in adolescent idiopathic scoliosis surgery

Scoliosis correction with pedicle screws in Duchenne muscular dystrophy

Anterior short correction in thoracic adolescent idiopathic scoliosis with mini-open thoracotomy approach: prospective clinical, radiological and pulmonary function results

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