The Relationship Between Deformity Correction and Clinical Outcomes After Thoracoscopic Scoliosis Surgery

Izatt, Maree T.; Adam, Clayton J.; Labrom, Robert D.; Askin, Geoffrey N.

doi:10.1097/brs.0b013e3181d12627

Cited by 15 publications

(5 citation statements)

References 36 publications

(40 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Multiple discectomies and compression along the rod lead to shortening of the anterior column and immediate increases in the thoracic kyphosis at the first erect radiograph after surgery, with further increases reported two years after anterior selective thoracic fusion [5,7,8,14,16,18]. Prior studies by our group on the larger cohort have reported complications associated with this type of surgery [8,41,58]. In the current cohort of 30 patients, there were 3 rod fractures and 3 top screw pullouts found by the most recent follow-up.…”

Section: Discussionmentioning

confidence: 96%

CT and radiographic analysis of sagittal profile changes following thoracoscopic anterior scoliosis surgery

et al. 2012

View full text Add to dashboard Cite

BackgroundPrevious studies report an increase in thoracic kyphosis after anterior approaches and a flattening of sagittal contours following posterior approaches. Difficulties with measuring sagittal parameters on radiographs are avoided with reformatted sagittal CT reconstructions due to the superior endplate clarity afforded by this imaging modality.MethodsA prospective study of 30 Lenke 1 adolescent idiopathic scoliosis (AIS) patients receiving selective thoracoscopic anterior spinal fusion (TASF) was performed. Participants had ethically approved low dose CT scans at minimum 24 months after surgery in addition to their standard care following surgery. The change in sagittal contours on supine CT was compared to standing radiographic measurements of the same patients and with previous studies. Inter-observer variability was assessed as well as whether hypokyphotic and normokyphotic patient groups responded differently to the thoracoscopic anterior approach.ResultsMean T5-12 kyphosis Cobb angle increased by 11.8 degrees and lumbar lordosis increased by 5.9 degrees on standing radiographs two years after surgery. By comparison, CT measurements of kyphosis and lordosis increased by 12.3 degrees and 7.0 degrees respectively. 95% confidence intervals for inter-observer variability of sagittal contour measurements on supine CT ranged between 5-8 degrees. TASF had a slightly greater corrective effect on patients who were hypokyphotic before surgery compared with those who were normokyphotic.ConclusionsRestoration of sagittal profile is an important goal of scoliosis surgery, but reliable measurement with radiographs suffers from poor endplate clarity. TASF significantly improves thoracic kyphosis and lumbar lordosis while preserving proximal and distal junctional alignment in thoracic AIS patients. Supine CT allows greater endplate clarity for sagittal Cobb measurements and linear relationships were found between supine CT and standing radiographic measurements. In this study, improvements in sagittal kyphosis and lordosis following surgery were in agreement with prior anterior surgery studies, and add to the current evidence suggesting that anterior correction is more capable than posterior approaches of addressing the sagittal component of both the instrumented and adjacent non instrumented segments following surgical correction of progressive Lenke 1 idiopathic scoliosis.

show abstract

Section: Discussionmentioning

confidence: 96%

CT and radiographic analysis of sagittal profile changes following thoracoscopic anterior scoliosis surgery

et al. 2012

View full text Add to dashboard Cite

show abstract

“…Does it really matter if the curve was reduced to 35° 25° or 15°? Several studies have shown that if the Cobb angle is reduced to 35° or less the SRS-22 outcome score will be the same for curves corrected to 35° or 25° or 15° [ 7 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

Surgical management of moderate adolescent idiopathic scoliosis with ApiFix®: a short peri- apical fixation followed by post-operative curve reduction with exercises

et al. 2015

View full text Add to dashboard Cite

Surgery in adolescent idiopathic scoliosis (AIS) is a major operative intervention where 10–12 vertebrae are instrumented and fused. A smaller motion preserving surgery would be more desirable for these otherwise healthy adolescents. The ApiFix® system is a novel less invasive short segment pedicle screw based instrumentation inserted around the apex of the main curve. The system has a ratchet mechanism that enables gradual postoperative device elongation and curve correction. The ratchet is activated by performing specific spinal exercises. The unique features of the device allow curve correction without fusion. The system which has a CE approval was employed in adolescents with main thoracic curves.More than a dozen of ApiFix surgeries have been performed so far. The preoperative Cobb angle was 45° ± 8, and 25° ± 8 at final follow up. The following is a report on three adolescent females aged 13–16 years with curves between 43°-53° and Risser sign of 1–4 who underwent surgery with ApiFix®. Two pedicle screws were inserted around the curve apex and the ratchet based device with polyaxial ring connectors was attached to the screws. No fusion attempt was made. Operative time was around one hour. Two weeks after surgery the patients were instructed to perform Schroth like daily exercises with the aim of rod elongation and gradual curve correction. Patients were followed between 6 months to 2 years. Curves were reduced and maintained between 22- 33°. Patients were pain free and were able to perform their spinal exercises. Postoperative gradual elongation of the device was observed. No screw loosening or rod breakage were observed. No adding on or curve progression was seen.Three factors may contribute to the ApiFix® success: polyaxial connections that prevent mechanical failure, gradual curve correction by spinal motion and spinal growth modulation. The ApiFix® system allows managing moderate AIS with a simple and minor surgical intervention. Recovery is rapid with negligible motion loss. It allows gradual and safe curve correction with high patient satisfaction. It may also serve as an internal brace for AIS.

show abstract

“…Izatt et al [30] prospectively reviewed 100 patients undergoing thoracoscopic scoliosis surgery for AIS. The patients reported good post-operative patient reported outcome scores [30]. Newton et al [31] reported similar good patient satisfaction scores in 41 patients undergoing anterior thoracoscopic scoliosis surgery for thoracic scoliosis.…”

Section: Surgical Treatmentmentioning

confidence: 99%

8 Adolescent Idiopathic Scoliosis

Cox¹,

Dingle²

2019

Surgery of the Thoracic Spine

View full text Add to dashboard Cite

Background:Scoliosis refers to deviation of spine greater than 10 degrees in the coronal plane. Idiopathic Scoliosis is the most common spinal deformity that develops in otherwise healthy children. The sub types of scoliosis are based on the age of the child at presentation. Adolescent idiopathic scoliosis (AIS) by definition occurs in children over the age of 10 years until skeletal maturity. Objective:The objective of this review is to outline the features of AIS to allow the physician to recognise this condition and commence early treatment, thereby optimizing patient outcome. Method:A thorough literature search was performed using available databases, including Pubmed and Embase, to cover important research published covering AIS. Conclusion:AIS results in higher incidence of back pain and discontent with body image. Curves greater than 50 degrees in thoracic region and greater than 30 degrees in lumbar region progress at a rate of 0.5 to 1 degree per year into adulthood. Curves greater than 60 degrees can lead to pulmonary functional deficit. Therefore once the disease is recognized, effective treatment should be instituted to address the deformity and prevention of its long-term sequelae.

show abstract

The Relationship Between Deformity Correction and Clinical Outcomes After Thoracoscopic Scoliosis Surgery

Cited by 15 publications

References 36 publications

CT and radiographic analysis of sagittal profile changes following thoracoscopic anterior scoliosis surgery

CT and radiographic analysis of sagittal profile changes following thoracoscopic anterior scoliosis surgery

Surgical management of moderate adolescent idiopathic scoliosis with ApiFix®: a short peri- apical fixation followed by post-operative curve reduction with exercises

8 Adolescent Idiopathic Scoliosis

Contact Info

Product

Resources

About