Hybrid versus total sublaminar wires in patients with spinal muscular atrophy undergoing scoliosis surgery

Abstract Background Early versions of spinal muscular atrophy (SMA) scoliosis correction surgery often involved sublaminar devices. Recently, the utilization of pedicle screws has gained much popularity. Pedicle screws are generally believed to provide additional deformity correction, but pedicle size and rotational deformity limit their application in the thoracic spine, resulting in a hybrid construct involving pedicle screws and sublaminar wire. Studies of the efficacy of hybrid instrumentation in SMA scoliosis are often limited by the scarcity of the disease itself. In this study, we aimed to compare the surgical outcomes between hybrid constructs involving pedicle screws and sublaminar wire and sublaminar wire alone in patients with SMA scoliosis. Methods We retrospectively reviewed the clinical records and radiographic assessments of patients with SMA scoliosis who underwent corrective surgery between 1993 and 2017. The radiographic assessments included deformity correction and progressive changes in the major curve angle, pelvic tilt (PT) and coronal balance (CB). The correction of deformities was observed postoperatively and at the patient’s 2-year follow-up to test the efficacy of each type of construct. Results Thirty-three patients were included in this study. There were 14 and 19 patients in the wiring and hybrid construct groups, respectively. The hybrid construct group demonstrated a higher major curve angle correction (50.5° ± 11.2° vs. 36.4° ± 8.4°, p < 0.001), a higher apical vertebral rotation correction (10.6° ± 3.9° vs. 4.8° ± 2.6°, p < 0.001), and a reduced progression of the major curve angle at the 2-year follow-up (5.1° ± 2.9° vs. 8.7° ± 4.8°, p < 0.001). A moderate correlation was observed between the magnitude of correction of the apical vertebral rotation angle and the major curve (r = 0.528, p = 0.002). Conclusion This study demonstrated that hybrid instrumentation can provide a greater magnitude of correction in major curve and apical rotation as well as less major curve progression than sublaminar wire instrumentation alone in patients with SMA scoliosis. Level of evidence III

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Hybrid versus Total Sublaminar Wires in Patients With Spinal Muscular Atrophy Undergoing Scoliosis Surgery

10.21203/rs.3.rs-604868/v1 ◽

2021 ◽

Author(s):

Shih-Hsiang Chou ◽

Wen-Wei Li ◽

Cheng-Chang Lu ◽

Kun-Ling Lin ◽

Sung-Yen Lin ◽

...

Keyword(s):

Spinal Muscular Atrophy ◽

Pedicle Screw ◽

Muscular Atrophy ◽

Deformity Correction ◽

Vertebral Rotation ◽

Major Curve ◽

Apical Vertebral Rotation ◽

Hybrid Instrumentation ◽

Hybrid Construct

Abstract BackgroundEarly versions of spinal muscular atrophy (SMA) scoliosis correction surgeries often involved sublaminar devices. Recently the utilization of pedicle screw is gaining much popularity. Pedicle screw generally believed to provide additional deformity correction, but pedicle size and rotational deformity limit the application of pedicle screw in the thoracic spine, resulting in a hybrid construct of the pedicle screw and sublaminar wire. Studies of the efficacy of hybrid instrumentation in SMA scoliosis is often limited by the scarcity of the disease itself. In this study, we aimed to compare the surgical outcome of using hybrid constructs of the pedicle screw and sublaminar wire and that of sublaminar wire alone in patients with SMA scoliosis.MethodsWe retrospectively reviewed the clinical records and radiographic assessments of patients with SMA scoliosis who underwent corrective surgery between 1993 and 2015. The radiographic assessments included the deformity correction and the progressive change of major curve angle, pelvic tilt (PT) and coronal balance (CB). The correction of deformities was observed postoperatively and at the patient’s 2-year follow-up to test the efficacy of each type of constructs.ResultsThirty-three patients were included in this study. There were 14 and 19 patients in the wiring and the hybrid construct groups, respectively. The hybrid construct demonstrated a higher major curve angle correction (50.5° ± 11.2° vs. 36.4° ± 8.4°, p < 0.001), a higher apical vertebral rotation correction (10.6° ± 3.9° vs. 4.8° ± 2.6°, p < 0.001), and reduced the progression of major curve angle after the 2-year follow-up (5.1° ± 2.9° vs. 8.7° ± 4.8°, p < 0.001). A moderate correlation was observed between the magnitude of correction of apical vertebral rotation angle and major curve (r = 0.528, p = 0.002).ConclusionThis study demonstrated that hybrid instrumentation can provide a greater magnitude of correction in major curve and apical rotation, as well as less major curve progression in comparison with sublaminar wire in patients with SMA scoliosis.Level of evidence III

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Continuous lengthening potential after four years of magnetically controlled spinal deformity correction in children with spinal muscular atrophy

Scientific Reports ◽

10.1038/s41598-020-79821-x ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Heiko M. Lorenz ◽

Marina M. Hecker ◽

Lena Braunschweig ◽

Batoul Badwan ◽

Konstantinos Tsaknakis ◽

...

Keyword(s):

Spinal Muscular Atrophy ◽

Spinal Deformity ◽

Muscular Atrophy ◽

Deformity Correction ◽

Pelvic Obliquity ◽

Complication Rates ◽

Scoliotic Curve ◽

Level Of Evidence ◽

Growing Rods

AbstractMagnetically controlled growing rods (MCGR) are commonly implanted for the treatment of early-onset scoliosis. While most authors report favorable short-term results, little is known about long-term deformity correction. This prospective cohort study assesses spinal deformity control in a homogeneous spinal muscular atrophy (SMA) patient group treated with MCGR implants, a standardized lengthening protocol and a minimum follow-up of four years. 17 SMA patients with progressive scoliosis were treated with MCGR implanted parallel to the spine with rib-to-pelvis fixation. Radiologic measurements were performed before and after MCGR implantation and during external lengthening procedures. These included measurements of the scoliotic curve, kyphosis, lordosis, pelvic obliquity and the spinal length. Additional clinical data of the complications were also analyzed. 17 children (mean age 7.4 years) were surgically treated and underwent a total of 376 lengthenings. Complication rates were 3.5% in respect to all interventions or 41% of the patients had complications during 3.5% of the lengthening sessions. The initial implantation significantly reduced the main scoliotic curve by 59%, with the correction remaining constant throughout the follow-up. Pelvic obliquity was also significantly and permanently corrected by 72%, whereas kyphosis and lordosis were not influenced. The spinal length could be significantly increased mostly during the first year of treatment. Bilateral implantation of MCGRs for correction of spinal deformity in children with SMA showed no decrease of the lengthening potential during a four-year follow-up. Therefore, the previously described ‘law of diminishing returns’ could not be applied to this patient population.Level of Evidence/Clinical relevance: Therapeutic Level IV.

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Hi-PoAD technique for Adolescent Idiopathic Scoliosis in Adult: Personal case series

European Spine Journal ◽

10.1007/s00586-021-06897-y ◽

2021 ◽

Author(s):

Cesare Faldini ◽

Francesca Barile ◽

Fabrizio Perna ◽

Stefano Pasini ◽

Michele Fiore ◽

...

Keyword(s):

Surgical Technique ◽

Idiopathic Scoliosis ◽

Case Series ◽

Deformity Correction ◽

Pedicle Screws ◽

Mechanical Complication ◽

Non Union ◽

Implant Retention ◽

Surgical Data

Abstract Purpose The aim of this article is to present an original surgical technique for the treatment of rigid Adult Idiopathic Scoliosis (AdIS) and the results at minimum 2 years follow-up in a cohort of 40 patients. Methods We retrospectively reviewed 40 patients affected by rigid AdIS, older than 40 years and operated with a posterior one stage surgical technique summarized with the acronym Hi-PoAD, (high-density pedicle screws, Ponte osteotomies, asymmetric rods contouring, direct vertebral rotation). The demographic and surgical data were collected, and the improvement of clinical scores and radiologic parameters was obtained after surgery, at 1 and 2 years and at final follow-up, to assess deformity correction, coronal and sagittal balance and clinical outcome. Results The average follow-up was 2.9 years (range 2–3.5). Average coronal Cobb angle decreased from 65.0° ± 8.4 to 18.9° ± 3.9 (p < 0.01). Rotation sagittal angle decreased from 26.2° ± 4.4° to 12.4° ± 2.8° (p < 0.01). Mean thoracic kyphosis improved from 23.1° ± 3.6° to 36.0° ± 3.9°. SRS-22 improved form 2.9 ± 0.4 to 3.7 ± 0.6 (p < 0.01). Four early post-operative deep wound infections were observed, all healed after debridement and implant retention. No mechanical complication, junctional kyphosis, deformity progression or non-union were recorded at the last follow-up. Conclusions Hi-PoAD technique proved to be safe and effective in the treatment of rigid Adult Idiopathic Scoliosis. The reason for the success is related to the combined strategies adopted, that dissipates corrective forces over several levels, reducing mechanical stress at the screw–bone interface and optimizing corrective potential.

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Concave or convex rod translation first in adolescent idiopathic scoliosis instrumentation with differential rod contouring?

Studies in Health Technology and Informatics - Research into Spinal Deformities 9 ◽

10.3233/shti210455 ◽

2021 ◽

Author(s):

X Wang ◽

CE Aubin ◽

RM Schwend

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Cobb Angle ◽

Thoracic Kyphosis ◽

Deformity Correction ◽

Vertebral Rotation ◽

Convex Side ◽

Bone Screw ◽

Apical Vertebral Rotation ◽

Clinically Significant

The objective was to assess deformity correction and bone-screw force associated respectively with concave manipulation first, convex manipulation first, and different differential rod contouring configurations. Instrumentation scenarios were computationally simulated for 10 AIS cases with mean thoracic Cobb angle (MT) of 54±8°, apical vertebral rotation (AVR) of 19±2° and thoracic kyphosis of 21±9°. Instrumentations with major correction maneuvers using the concave side rod were first simulated; instrumentations with major correction maneuvers using the convex side rod were then simulated. Simulated correction maneuvers were concave/convex rod translation followed by apical vertebral derotation and then convex/concave rod translation. There were no significant differences in deformity corrections and bone-screw forces between concave rod translation first and convex rod translation first with differential rod contouring. Increasing differential rod contouring angle and concave rod diameter improved AVR correction and increased the TK and bone-screw forces; the effect on the MT Cobb angle was not clinically significant.

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THE USE OF NITINOL RODS IN SURGICAL TREATMENT OF DEGENERATIVE SCOLIOSIS. 2.5-YEAR FOLLOW-UP

Coluna/Columna ◽

10.1590/s1808-185120161501156149 ◽

2016 ◽

Vol 15 (1) ◽

pp. 22-25

Author(s):

Natalia Sergeyevna Morozova ◽

Dmitriy Aleksandrovich Kolbovsky ◽

Arkadiy Ivanovich Kazmin ◽

Sergey Vasilievich Kolesov

Keyword(s):

Surgical Treatment ◽

Interbody Fusion ◽

Deformity Correction ◽

Pedicle Screws ◽

Control Group ◽

Rigid Fixation ◽

Degenerative Lumbar Scoliosis ◽

Lumbosacral Region ◽

Pedicle Fixation

ABSTRACT Objectives: To compare the outcomes of surgical treatment with lumbar fixation using nitinol rods without fusion and with standard lumbar fixation with titanium rods and interbody fusion. Methods: Treatment results of 70 patients with degenerative lumbar scoliosis aged 40 to 82 were analyzed. In all cases pedicle screws and nitinol rods with a diameter of 5.5 mm were used. Thirty patients underwent fixation at L1-S1 and 40 patients underwent fixation at L1-L5. Spinal fusion was not performed. All patients had radiography, CT and MRI performed. The results were assessed according to the Oswestry scale, SRS 22, SF 36 and VAS. The minimum follow-up period for all patients was 2.5 years. For the control group, consisting of 72 patients, pedicle fixation with titanium rods and interbody fusion in the lumbosacral region were performed. Results: The average level of deformity correction equaled 25° (10° - 38°). The analysis of X-ray and CT-scans revealed a single patient with implant instability, two patients with bone resorption around the screws and one patient with rod fractures. Functional radiography 2.5 years after surgery showed an average mobility of the lumbar spine of 21° (15° - 30°). There were no problems at the adjacent levels. Conclusions: The use of nitinol rods in spinal deformity surgery is promising. This technology is an alternative to rigid fixation. Continued gathering of clinical data and its further evaluation is necessary.

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P.351Gene-replacement therapy (GRT) in spinal muscular atrophy type 1 (SMA1): long-term follow-up from the onasemnogene abeparvovec phase 1/2a clinical trial

Neuromuscular Disorders ◽

10.1016/j.nmd.2019.06.513 ◽

2019 ◽

Vol 29 ◽

pp. S184

Author(s):

J. Mendell ◽

R. Shell ◽

K. Lehman ◽

M. McColly ◽

L. Lowes ◽

...

Keyword(s):

Clinical Trial ◽

Spinal Muscular Atrophy ◽

Replacement Therapy ◽

Muscular Atrophy ◽

Phase 1 ◽

Spinal Muscular Atrophy Type ◽

Long Term Follow Up

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

Journal of Neurosciences in Rural Practice ◽

10.4103/0976-3147.185510 ◽

2016 ◽

Vol 7 (04) ◽

pp. 550-553 ◽

Cited By ~ 4

Author(s):

Sohail Rafi ◽

Naseem Munshi ◽

Asad Abbas ◽

Rabia Hassan Shaikh ◽

Imtiaz Hashmi

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Cobb Angle ◽

Pedicle Screw ◽

Pedicle Screws ◽

Scoliosis Surgery ◽

Hybrid Instrumentation ◽

System Versus ◽

Cobb’S Angle

ABSTRACT Introduction: Adolescent idiopathic scoliosis is the most common type of scoliosis. A Cobb angle of 50° will progress beyond the age of spinal maturity. Surgery over bracing is advised at a Cobb angle above or equal to 50°. The aim of surgery is to bring the Cobb angle down below 50° to prevent reprogression as well as improve the quality of life. The objective of the study is to analyze the efficacy and significance in lifestyle improvement of pedicle screw-only fixation system versus the more common hybrid instrumentation system used for the surgical treatment of adolescent idiopathic scoliosis. Materials and Methods: A prospective cohort study was conducted involving two groups of patients were included in the study. One group was operated with pedicle screw-only method while the other with hybrid instrumentation system. The pre- and post-operative Cobb’s angles were taken across a follow-up of 4 years. An SRS-30 questionnaire was given in a yearly follow-up to assess the lifestyle improvement of the patient. Results: Pedicle screw-only method was significantly more effective in reducing Cobb’s angle (P = 0.0487). It was showed less loss of correction (P = 0.009) pedicle screw-only surgery was also better at reducing thoracic curves (P = 0.001). There seemed a better recovery time with pedicle screw surgery (P = 0.003). Conclusion: Pedicle screws are more effective and durable than hybrid systems at when treating adolescent idiopathic scoliosis.

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