Treatment of severe scoliosis with posterior-only approach arthrodesis and all-pedicle screw instrumentation

Abstract

Purpose Posterior-only approach arthrodesis by all-pedicle screw instrumentation has a correction rate similar to correction obtained by traditional combined anterior/posterior approach surgery and avoids the complications associated with the thoracic approach. Methods We treated 25 patients, with a mean age 16.5 years, with severe adolescent idiopathic scoliosis by posterior-only approach using all-screw instrumentation arthrodesis. Mean scoliosis curve in Cobb degrees was 95°C obb. All cases were treated by the same senior surgeon, by free hand technique, without intraoperative neurophysiologic monitoring and spine navigation aids. Results Mean scoliosis curve after surgery was 37°Cobb. Mean follow-up was 4 years. No perioperative complications, curve progression or arthrodesis malunion were reported at the follow-up. Conclusions Posterior spinal fusion with pedicle screwonly instrumentation obtains a good and stable correction of severe scoliosis; compared to hybrid instrumentation, it allows a greater coronal correction of the deformity and less correction loss at the follow-up.

The Michel Benoist and Robert Mulholland Yearly European Spine Journal Review: a survey of the “surgical and research” articles in the European Spine Journal, 2013

“…Supplement 6, which included some 29 papers selected from the meeting in 2012 of the Italian Spine Society, had a number of interesting papers. The paper by Crostelli et al [68] gives further evidence that posterior correction of severe adolescent scoliosis by the posterior approach only, but using pedicle screws throughout the thoracic spine is as effective, and in some respects better than combined anterior and posterior procedures, and with less morbidity.…”

High Density Pedicle Screws through Posterior Only Approach for Surgical Correction of Severe Adolescent Idiopathic Scoliosis > 70o

“…1,3,4,8,9,15,23 We think that increasing implant density as well as using extended head reduction screws on concave side in our patients offered an efficient derotation maneuver and this may have resulted in better curve correction. Also, the routine Ponte osteotomies in all patients and asymmetrical PSO in very rigid curves improved curve correction and may also explain the better coronal correction in this study.…”

“…8 The combined anterior and posterior procedure can be performed in one or two stage surgery with or without halo traction in-between. 2,26 Additional anterior surgery requires increased time for the general anesthesia and may have a negative impact on pulmonary function, longer hospital stay, more blood loss and longer operative time.…”

Idiopatinės Skoliozės Pooperacinės Korekcijos Priklausomybė Nuo Fiksavimo Būdo

“…Vėliau pradėti naudoti pedikuliniai sraigtai [3]. Dauguma autorių teigia, kad pedikulinių sraigtų naudojimas didina korekcijos trijose plokštumose galimybes, trumpina fiksacijos ilgį, mažina torakoplastikos naudojimą, mažina pooperacinį korekcijos netekimą [4][5][6][7]. Prieš 10 metų buvo sunkiai suvokiama, kad sraigtus galima bus sukti ne tik į juosmeninę, bet ir į krūtininę dalį.…”

“…Tačiau dėl multisegmentinės fiksacijos gydymo išlaidos padidėjo 2-3 kartus [9], padidėjo komplikacijų skaičius [10][11][12], pailgėjo operacijos laikas, padidėjo kraujavimas operacijos metu [13]. Didėjant patyrimui, operacinei technikai, ryškiai sutrumpėjo operacijos laikas, kraujo netekimas operacijos metu bei komplikacijų skaičius [6,7].…”