Correction of adolescent idiopathic scoliosis using a convex pedicle screw technique with low implant density

2021 ◽  
Vol 103-B (3) ◽  
pp. 536-541
Author(s):  
Peter W. Ferlic ◽  
Laurenz Hauser ◽  
Michael Götzen ◽  
Richard Andreas Lindtner ◽  
Stefan Fischler ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Cobb Angle ◽  
Pedicle Screw ◽  
Operating Time ◽  
Pedicle Screws ◽  
Patient Reported ◽  
Group 2 ◽  
Implant Density ◽  
Group 1

Aims The aim of this retrospective study was to compare the correction achieved using a convex pedicle screw technique and a low implant density achieved using periapical concave-sided screws and a high implant density. We hypothesized that there would be no difference in outcome between the two techniques. Methods We retrospectively analyzed a series of 51 patients with a thoracic adolescent idiopathic scoliosis. There were 26 patients in the convex pedicle screw group who had screws implanted periapically (Group 2) and a control group of 25 patients with bilateral pedicle screws (Group 1). The patients’ charts were reviewed and pre- and postoperative radiographs evaluated. Postoperative patient-reported outcome measures (PROMs) were recorded. Results The number of implants (14.5 vs 17.1) and the implant density (1.5 vs 1.9) were significantly lower in Group 2 (p < 0.001). Operating time was 27 minutes shorter in Group 2 than in Group 1, with a mean of 217 minutes (SD 50.5; 120 to 346). The duration of surgery per instrumented vertebra was reduced by 19% in Group 2 (p = 0.011). No statistical difference was found in the postoperative Cobb angle, vertebral rotation, the relative correction achieved, or postoperative PROMs. Conclusion Despite a lower implant density and achieving correction through a convex rod, surgical correction of the Cobb angle and vertebral body rotation was similar in both groups. Periapical pedicle screws and primary correction on the concave side do not seem to be mandatory in order to achieve good surgical results in idiopathic thoracic scoliosis. The operating time was shorter in the group with lower implant density. In conclusion, the technique provided good results and has the potential to reduce complications and costs. Cite this article: Bone Joint J 2021;103-B(3):536–541.

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

2016 ◽  
Vol 7 (04) ◽  
pp. 550-553 ◽  
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.

scholarly journals Radiological outcomes of the selective spinal fusion for lenke type 5C adolescent idiopathic scoliosis

2021 ◽  
Vol 13 (1) ◽  
pp. 6-9
Author(s):  
Ghanshyam Kakadiya ◽  
Kalpesh Saindane ◽  
Viraj Gandbhir ◽  
Yogesh Soni, ◽  
Kushal Gohil ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Cobb Angle ◽  
Spinal Instrumentation ◽  
Pedicle Screws ◽  
P Value ◽  
Coronal Balance ◽  
Angle Correction ◽  
The Mean ◽  
Implant Density

Objective: To determine the short term radiological outcomes of Lenke type 5C adolescent idiopathic scoliosis in terms of Cobb angle correction and coronal balance after selective posterior segmental spinal instrumentation with pedicle screws. Methods: This retrospective cohort study was conducted in the department of Orthopaedic at tertiary care public hospital of Mumbai, India. The medical records of patients from 17th April 2015 to 29th October 2019 who underwent a selective spinal fusion with pedicle screws for Lenke type-5C adolescent idiopathic scoliosis were reviewed. Preoperative radiographs were evaluated for Cobb angle of the lumbar or thoracolumbar curve as well as a sagittal and lumbar modifier on anteroposterior and lateral standing films. The curve correction, implant density, number of segment fused and coronal balance was assessed on postoperative radiographs. The pre and postoperative comparison of important study variables was done and P-value was calculated with the help of the chi-square test. P-value <0.05 was considered statistically significant. Results: The total number of patients was 34. Majority (94.1%, n=32) were females while only 2(5.9%) were males. The mean age at the time of operation was 14.35±2.19 years (range 8 to 19 years). Mean pre-operative and post-operative Cobb angles were 61.790±13.120 (range 400 to 850) and 10.550±8.710 (range 00 to 300) respectively (P-value 0.00). The mean percentage of curve correction and percentage of fulcrum flexibility was 83.35±13.07 % (range 55% to 100%) and 59.56%±15.07 (range 28.57% to 84.60%) respectively (P value 0.469). Mean implant density and fusion mass was 66.03±7.94% (range 53 to 79%) and 10.32±2.8 (range 7 to 15%) segments respectively. The coronal balance was achieved in all patients. No major complication was noted. Conclusion: Near normal Cobb angle correction and coronal balance was achieved in all patients of Lenke type 5C adolescent idiopathic scoliosis treated with posterior segmental spinal instrumentation utilizing pedicle screws.

scholarly journals Effective dose of radiation per screw in surgery of adolescent idiopathic scoliosis: matched pair analysis of 293 pedicle screws inserted using three different techniques

2020 ◽  
Vol 14 (6) ◽  
pp. 554-561
Author(s):  
Markus Rafael Konieczny ◽  
Johannes Boos ◽  
Andrea Steuwe ◽  
Christoph Schleich ◽  
Max Prost ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Effective Dose ◽  
Pedicle Screw ◽  
Image Acquisition ◽  
Pedicle Screws ◽  
Matched Pair ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Group 1

Purpose Reports on heterogenous groups of patients have indicated that pedicle screw insertion guided by navigation (PIN) leads to, for the patient, higher doses of radiation compared with pedicle screw insertion guided by fluoroscopy (PIF). This would be a major concern, especially in paediatric deformity correction. Methods After a power analysis (aiming at > 0.8) 293 pedicle screws which were inserted in patients with adolescent idiopathic scoliosis were analyzed by comparing effective dose and fluoroscopy time per screw for three different techniques. Groups 2 and 3 were matched to Group 1 by Lenke type of scoliosis. Group 1 were prospectively enrolled consecutive patients that have been operated on by PIN with image acquisition by preoperative CT scan (CTS). Group 2 were consecutive retrospectively matched patients who have been operated on by PIN with image acquisition by an intraoperative 3D scan (3DS). Group 3 were consecutive retrospectively matched patients who have been operated on by PIF. Results Mean dose of radiation per screw was 1.0 mSv (sd 0.8) per screw in CTS patients, 0.025 mSv (sd 0.001) per screw in 3DS patients and 0.781 mSv (sd 0.12) per screw in PIF patients. The difference was significant (p < 0.0001). Conclusion When we compared different techniques of navigation, navigation by image acquisition with CTS showed a significantly higher (by 97.5%) dose of radiation per screw for the patient than navigation by image acquisition by a 3DS. Navigation by 3DS showed significantly lower effective dose per screw for the adolescent patients than the fluoroscopic technique. Level of Evidence: II

Predicted final spinal height in patients with adolescent idiopathic scoliosis can be achieved by surgery regardless of maturity status

2018 ◽  
Vol 100-B (10) ◽  
pp. 1372-1376 ◽  
Author(s):  
H. Bao ◽  
Z. Liu ◽  
M. Bao ◽  
Z. Zhu ◽  
P. Yan ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Growth Restriction ◽  
Fusion Surgery ◽  
Group 4 ◽  
Selective Fusion ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Aims The aim of this study was to investigate the impact of maturity status at the time of surgery on final spinal height in patients with an adolescent idiopathic scoliosis (AIS) using the spine-pelvic index (SPI). The SPI is a self-control ratio that is independent of age and maturity status. Patients and Methods The study recruited 152 female patients with a Lenke 1 AIS. The additional inclusion criteria were a thoracic Cobb angle between 45° and 70°, Risser 0 to 1 or 3 to 4 at the time of surgery, and follow-up until 18 years of age or Risser stage 5. The patients were stratified into four groups: Risser 0 to 1 and selective fusion surgery (Group 1), Risser 0 to 1 and non-selective fusion (Group 2), Risser 3 to 4 and selective fusion surgery (Group 3), and Risser 3 to 4 and non-selective fusion (Group 4). The height of spine at follow-up (HOSf) and height of pelvis at follow-up (HOPf) were measured and the predicted HOS (pHOS) was calculated as 2.22 (SPI) × HOPf. One-way analysis of variance (ANOVA) was performed for statistical analysis. Results Of the 152 patients, there were 32 patients in Group 1, 27 patients in Group 2, 48 patients in Group 3, and 45 patients in Group 4. Significantly greater HOSf was observed in Group 3 compared with Group 1 (p = 0.03) and in Group 4 compared with Group 2 (p = 0.02), with similar HOPf (p = 0.75 and p = 0.83, respectively), suggesting that patients who undergo surgery at Risser grade of 0 to 1 have a shorter spinal height at follow-up than those who have surgery at Risser 4 to 5. HOSf was similar to pHOS in both Group 1 and Group 2 (p = 0.62 and p = 0.45, respectively), indicating that undergoing surgery at Risser 0 to 1 does not necessarily affect final spinal height. Conclusion This study shows that fusion surgery at Risser 0 may result in growth restriction unlike fusion surgery at Risser 3 to 4. Despite such growth restriction, AIS patients could reach their predicted or ‘normal’ spinal height after surgery regardless of baseline maturity status due to the longer baseline spinal length in AIS patients and the remaining growth potential at the non-fusion levels. Cite this article: Bone Joint J 2018;100-B:1372–6.

scholarly journals Preoperative Assessment of the Feasibility of Pedicle Screw Insertion at the Proximal Thoracic Curve in Lenke Type 2 Idiopathic Scoliosis

2019 ◽  
Vol 10 (3) ◽  
pp. 261-265
Author(s):  
Yuki Taniguchi ◽  
Yoshitaka Matsubayashi ◽  
So Kato ◽  
Takashi Ono ◽  
Yasushi Oshima ◽  
...  
Keyword(s):  
Idiopathic Scoliosis ◽  
Cobb Angle ◽  
Pedicle Screw ◽  
Pedicle Screws ◽  
Preoperative Assessment ◽  
Japanese Patients ◽  
Minimal Distance ◽  
Screw Insertion ◽  
The Right

Study Design: Retrospective cohort study. Objectives: To investigate the feasibility of inserting pedicle screws in the proximal thoracic (PT) curve in Lenke type 2 idiopathic scoliosis, using post-myelography computed tomography (CT). Methods: Post-myelography CT images of 46 Japanese patients, 10 to 30 years old, who underwent surgery for Lenke type 2 idiopathic scoliosis were analyzed. A new parameter “SAPS” (space available for pedicle screw) was introduced, which defines the minimal distance between the lateral cortex of the pedicle and the spinal cord, with a SAPS <4.5 mm being “unacceptable.” All 460 pedicles (T2 through T6) were analyzed. Pedicle diameter was classified according to the Akazawa grading system. Results: Most pedicles on the right side at T3 (84.8%) and T4 (97.8%) were unacceptable. The unacceptable rate was 58.7% and 15.2% on the right side at T5 and T6, respectively. A larger Cobb angle of the PT curve was associated with a greater incidence of unacceptable SAPS at these levels. For a Cobb angle of the PT curve >40°, most right T5 pedicles were unacceptable. On the left side, most pedicles from T2 to T5 were acceptable. When T5 was the caudal end vertebra of the PT curve, the left T6 pedicles had an unacceptable SAPS in some cases. When the width of the pedicle channel was ≥2 mm (Akazawa grade 1 or 2), all pedicles from T2 to T6, on both sides, were acceptable. Conclusions: Post-myelography CT enabled us to clearly demonstrate the feasibility of inserting pedicle screws in the PT region.

scholarly journals Corrective Bracing for Severe Idiopathic Scoliosis in Adolescence: Influence of Brace on Trunk Morphology

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Edyta Kinel ◽  
Tomasz Kotwicki ◽  
Wanda Stryła ◽  
Andrzej Szulc
Keyword(s):  
Surgical Treatment ◽  
Idiopathic Scoliosis ◽  
Cobb Angle ◽  
Surface Topography ◽  
Adolescent Girls ◽  
Trunk Rotation ◽  
Brace Treatment ◽  
Group 2 ◽  
Posterior Trunk ◽  
Group 1

Aim. The aim of the work was to study whether wearing a corrective brace by adolescent girls with severe idiopathic scoliosis can influence external shape of the trunk.Methods. Comparison of clinical deformity of two groups of girls matched for age and Cobb angle: group (1) of 23 girls, aged14.9±1.3years, Cobb angle55.0°±6.8°, who refused surgical treatment and have been wearing Chêneau brace for more than 6 months, compared with group (2) of 22 girls, aged14.1±1.8years, Cobb angle59.7°±14.6°never treated with corrective bracing. Clinical deformity was assessed with the Bunnell scoliometer (angle of trunk rotation ATR) and surface topography (posterior trunk symmetry index POTSI and Hump Sum HS).Results.The ATR in the primary curvature was11.9°±3.4°(5°–18°) in group 1 versus15.1°±5.6°(6°–25°) in group 2 (P=0.027). The HS was16.8°±3.8versus19.2°±4.6, respectively,P=0.07. The POTSI value did not differ between groups.Conclusion. Girls with Cobb angle above 45 degrees, who have been subjected to brace treatment, revealed smaller clinical deformity of their back comparing to nontreated girls having similar radiological curvatures.

scholarly journals Long-Term Surgical Results of Skip Pedicle Screw Fixation for Patients with Adolescent Idiopathic Scoliosis: A Minimum-Ten-Year Follow-Up Study

2020 ◽  
Vol 9 (12) ◽  
pp. 4002
Author(s):  
Masashi Uehara ◽  
Shugo Kuraishi ◽  
Shota Ikegami ◽  
Hiroki Oba ◽  
Takashi Takizawa ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Cobb Angle ◽  
Pedicle Screw ◽  
Screw Fixation ◽  
Pedicle Screw Fixation ◽  
Patient Questionnaire ◽  
The Mean

Skip pedicle screw fixation for adolescent idiopathic scoliosis (AIS) requires fewer screws and can reduce the risk of neurovascular injury as compared with segmental pedicle screw fixation. However, the long-term impact of screw number reduction on correction and clinical results is unclear. This study examined the 10-year post-operative outcomes of skip pedicle screw fixation for patients with AIS. We reviewed the outcomes of 30 patients who underwent skip pedicle screw fixation for AIS. Radiological and clinical findings were assessed before and immediately, 2 years, and 10 years after surgery in the remaining 25 patients. The mean Cobb angle of the main curve preoperatively and immediately, 2 years, and 10 years post-operatively was 59.4°, 23.4°, 25.8°, and 25.60°, respectively, and was significantly improved at all post-surgical time points (all p < 0.001). The mean correction rate immediately after surgery was 60.8%, and the correction loss rate at the observation end point was 4.8%. The Cobb angle of the lumbar curve was significantly improved immediately after surgery, and the correction persisted until 10 years post-operatively. Remarkable gains were observed for most Scoliosis Research Society-22 patient questionnaire sub-scores at the final follow-up versus preoperative assessments. In conclusion, good correction of the AIS deformity by skip pedicle screw fixation was well maintained over a long follow-up period of 10 years, with clinically meaningful gains in Society-22 patient questionnaire sub-scores.

scholarly journals Incidence of Proximal Junctional Kyphosis With Pedicle Screws at Upper Instrumented Vertebrae in Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis

2020 ◽  
pp. 219256822093510
Author(s):  
Yoji Ogura ◽  
Steven D. Glassman ◽  
Daniel Sucato ◽  
M. Timothy Hresko ◽  
Leah Y. Carreon
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Spinal Fusion ◽  
Pedicle Screw ◽  
Standard Procedure ◽  
Pedicle Screws ◽  
Posterior Spinal Fusion ◽  
Proximal Junctional Kyphosis ◽  
The Impact ◽  
Junctional Kyphosis

Study Design: Longitudinal cohort. Objectives: Posterior spinal fusion (PSF) using all-pedicle screw constructs has become the standard procedure in the treatment of adolescent idiopathic scoliosis (AIS). However, there have been several reports that all-pedicle screw constructs or the use of pedicle screws at the upper instrumented vertebrae (UIV) increases the incidence of proximal junctional kyphosis (PJK). We aimed to evaluate the impact of instrumentation type on the incidence of PJK following PSF for AIS. Methods: We performed a stratified random sampling from 3654 patients enrolled in a multicenter database of surgically treated AIS to obtain a representative sample from all Lenke types. Patients were then allocated into 3 groups based on the instrumentation type: all-pedicle screw (PS), hook at UIV with pedicle screws distally (HT), and hybrid constructs (HB). We measured proximal junctional angle (PJA) and defined PJK as PJA ≥ 10° and PJA progression of >10° at the final follow-up. Results: Fifteen (4.3%) of 345 cases had PJK. PJK was significantly more common in PS (11%) compared with HB (1%) and HT (0%) ( P < .001). PJK patients were similar to non-PJK patients regarding age, sex, curve type, UIV, and preoperative coronal Cobb angle. Thoracic kyphosis was significantly higher in the PJK group before surgery. Patients who developed PJK had a statistically significantly larger negative sagittal balance compared with the non-PJK group. Conclusion: The incidence of PJK was 4.3% and was more common in all-pedicle screw constructs. Using hooks at UIV might be a treatment strategy to limit PJK.

scholarly journals Exploring the Pathological Role of Collagen in Paravertebral Muscle in the Progression of Idiopathic Scoliosis

2020 ◽  
Vol 2020 ◽  
pp. 1-12
Author(s):  
Haidong Peng ◽  
Feng Jin ◽  
Depeng Meng ◽  
Jun Li ◽  
Shuhan Yu ◽  
...  
Keyword(s):  
Idiopathic Scoliosis ◽  
Cobb Angle ◽  
Muscle Stiffness ◽  
Concave Side ◽  
Paravertebral Muscle ◽  
Group 4 ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Background. Paravertebral muscle (PVM) is considered as a contributing factor of idiopathic scoliosis (IS); collagen is crucial for maintaining the mechanical properties of PVM, but only a few researches have described this field. In this study, we observed the muscle stiffness of PVM and the curvature of the spine by adjusting the content of collagen in PVM of rats and explored the role of collagen in the progression of IS. Methods. 32 female Sprague Dawley rats were randomly divided into four groups: neutralizing antibody (NA) group (group 1), normal control group (group 2), IS group (group 3), and IS with NA group (group 4). TGF-β1 NA was injected into PVM in group 1 and group 4, while Normal saline in group 2 and group 3. The Cobb angle and muscle stiffness were measured before and after injection; the rats were sacrificed at one week after injection, and performed histological, Western Blot, and qRT-PCR examinations. Results. X-rays showed that scoliosis occurred in group 1 and relieved in group 4. The stiffness of PVM was decreased significantly on the convex side in group 1, while on the concave side in group 4. The expression of TGF-β1 and COL1 on the concave side in IS rats (group 3) was significantly increased than that in normal rats (group 2), the concentration of COL1 and COL3 in group 3 was significantly higher than that in group 2, and the addition of TGF-β1 NA significantly downregulated COL1 and COL3 in group 1 and group 4. The concentration of COL1 in convex PVM was negatively related to Cobb angle in group 1 and group 2, and in concave PVM was positively related to Cobb angle in group 3 and group 4. However, no significant correlation was found between COL3 and Cobb angle in group 3 and group 4. Conclusions. Asymmetric biomechanical characteristics of PVM was an important etiological factor of IS, which was directly correlated with collagen, it could be adjusted by local intramuscular injecting of TGF-β1 NA, and finally had an effect on the shape of the spine.

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