Minimally invasive scoliosis surgery assisted by O-arm navigation for Lenke Type 5C adolescent idiopathic scoliosis: a comparison with standard open approach spinal instrumentation

OBJECTIVE Recently, minimally invasive scoliosis surgery (MISS) was introduced for the correction of adult scoliosis. Multiple benefits including a good deformity correction rate and fewer complications have been demonstrated. However, few studies have reported on the use of MISS for the management of adolescent idiopathic scoliosis (AIS). The purpose of this study was to investigate the outcome of posterior MISS assisted by O-arm navigation for the correction of Lenke Type 5C AIS. METHODS The authors searched a database for all patients with AIS who had been treated with either MISS or PSF between November 2012 and January 2014. Levels of fusion, density of implants, operation time, and estimated blood loss (EBL) were recorded. Coronal and sagittal parameters were evaluated before surgery, immediately after surgery, and at the last follow-up. The accuracy of pedicle screw placement was assessed according to postoperative axial CT images in both groups. The 22-item Scoliosis Research Society questionnaire (SRS-22) results and complications were collected during follow-up. RESULTS The authors retrospectively reviewed the records of 45 patients with Lenke Type 5C AIS, 15 who underwent posterior MISS under O-arm navigation and 30 who underwent posterior spinal fusion (PSF). The 2 treatment groups were matched in terms of baseline characteristics. Comparison of radiographic parameters revealed no obvious difference between the 2 groups immediately after surgery or at the final follow-up; however, the MISS patients had significantly less EBL (p < 0.001) and longer operation times (p = 0.002). The evaluation of pain and self-image using the SRS-22 showed significantly higher scores in the MISS group (p = 0.013 and 0.046, respectively) than in the PSF group. Postoperative CT showed high accuracy in pedicle placement in both groups. No deep wound infection, pseudarthrosis, additional surgery, implant failure, or neurological complications were recorded in either group. CONCLUSIONS Minimally invasive scoliosis surgery is an effective and safe alternative to open surgery for patients with Lenke Type 5C AIS. Compared with results of the open approach, the outcomes of MISS are promising, with reduced morbidity. Before the routine use of MISS, however, long-term data are needed.

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Answer to the Letter to Editor of S. Kumar et al. concerning “Safety and effectiveness of minimally invasive scoliosis surgery for adolescent idiopathic scoliosis: a retrospective case series of 84 patients” by Yang JH, et al. (Eur Spine J [2020]; 29: 761–769)

European Spine Journal ◽

10.1007/s00586-021-06846-9 ◽

2021 ◽

Author(s):

Dong-Gune Chang ◽

Seung Woo Suh

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Minimally Invasive ◽

Idiopathic Scoliosis ◽

Case Series ◽

Scoliosis Surgery ◽

Retrospective Case ◽

Retrospective Case Series

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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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109. Proximal junctional change in adolescent idiopathic scoliosis following segmental posterior spinal instrumentation and fusion: minimum 5 year follow up

The Spine Journal ◽

10.1016/j.spinee.2004.05.110 ◽

2004 ◽

Vol 4 (5) ◽

pp. S56

Author(s):

Yong-Jung Kim ◽

Keith Bridwell ◽

Lawrence Lenke ◽

Junghoon Kim ◽

Samuel Cho

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Spinal Instrumentation

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Safety and effectiveness of minimally invasive scoliosis surgery for adolescent idiopathic scoliosis: a retrospective case series of 84 patients

European Spine Journal ◽

10.1007/s00586-019-06172-1 ◽

2019 ◽

Vol 29 (4) ◽

pp. 761-769 ◽

Cited By ~ 1

Author(s):

Jae Hyuk Yang ◽

Dong-Gune Chang ◽

Seung Woo Suh ◽

Neelesh Damani ◽

Hoon-Nyun Lee ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Minimally Invasive ◽

Idiopathic Scoliosis ◽

Case Series ◽

Scoliosis Surgery ◽

Retrospective Case ◽

Retrospective Case Series

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Proximal fusion constructs in minimally invasive scoliosis surgery are successful without interbody or intertransverse fusion

Journal of Neurosurgery Spine ◽

10.3171/2019.5.spine19192 ◽

2019 ◽

Vol 31 (6) ◽

pp. 851-856

Author(s):

S. Shelby Burks ◽

Juan S. Uribe ◽

John Paul G. Kolcun ◽

Adisson Fortunel ◽

Jakub Godzik ◽

...

Keyword(s):

Minimally Invasive ◽

Deformity Correction ◽

Scoliosis Surgery ◽

Inclusion Criteria ◽

Female Ratio ◽

Adult Deformity ◽

Male Female Ratio ◽

Invasive Techniques

OBJECTIVEMinimally invasive techniques are increasingly used in adult deformity surgery as surgeon familiarity improves and long-term data are published. Concerns raised in such cases include pseudarthrosis at levels where interbody grafts are not utilized. Few previous studies have specifically examined the thoracolumbar component of long surgical constructs, which is commonly instrumented without interbody or intertransverse fusion.METHODSA retrospective analysis was performed on all patients who underwent hybrid minimally invasive deformity corrections in two academic spine centers over a 9-year period. Inclusion criteria were at least 2 rostral levels instrumented percutaneously, ranging from T8 to L1 as the upper end of the construct. Fusion assessment was made using CT when possible or radiography. Common radiographic parameters and clinical variables were assessed pre- and postoperatively.RESULTSA total of 36 patients fit the inclusion criteria. Baseline characteristics included a 1:1.8 male/female ratio, average age of 65.7 years, and BMI of 30.2 kg/m2. Follow-up imaging was obtained at a mean of 35.7 months. The average number of levels fused was 7.5, with an average of 3.4 instrumented percutaneously between T8 and L1, representing a total of 120 rostral levels instrumented percutaneously. Fusion assessment was performed using CT in 69 levels and radiography in 51 levels. Among the 120 rostral levels instrumented percutaneously, robust fusion was noted in 25 (20.8%), with 53 (44.2%) exhibiting some evidence of fusion. Pseudarthrosis was noted in 2 rostral segments (1.7%). There were no instances of proximal hardware revision. Eight patients exhibited radiographic proximal junctional kyphosis (PJK; 22.2%), none of whom underwent surgical intervention.CONCLUSIONSIn the present series of adult patients with scoliosis undergoing thoracolumbar deformity correction, rostral segments instrumented percutaneously have a very low rate of pseudarthrosis, with radiographic evidence of bone fusion occurring in more than 60% of patients. The rate of PJK was acceptable and similar to other published series.

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Minimally Invasive Scoliosis Surgery Is a Feasible Option for Management of Idiopathic Scoliosis and Has Equivalent Outcomes to Open Surgery: A Meta-Analysis

Global Spine Journal ◽

10.1177/2192568220988267 ◽

2021 ◽

pp. 219256822098826

Author(s):

Abduljabbar Alhammoud ◽

Yahya Alborno ◽

Abdul Moeen Baco ◽

Yahya Azhar Othman ◽

Yoji Ogura ◽

...

Keyword(s):

Postoperative Pain ◽

Blood Loss ◽

Minimally Invasive ◽

Idiopathic Scoliosis ◽

Operative Time ◽

Meta Analysis ◽

Scoliosis Surgery ◽

Curve Correction ◽

Estimated Blood Loss ◽

Feasible Option

Study Design: Meta-analysis. Objective: To compare outcomes between minimally invasive scoliosis surgery (MISS) and traditional posterior instrumentation and fusion in the correction of adolescent idiopathic scoliosis (AIS). Methods: A literature search was performed using MEDLINE, PubMed, EMBASE, Google scholar and Cochrane databases, including studies reporting outcomes for both MISS and open correction of AIS. Study details, demographics, and outcomes, including curve correction, estimated blood loss (EBL), operative time, postoperative pain, length of stay (LOS), and complications, were collected and analyzed. Results: A total of 4 studies met the selection criteria and were included in the analysis, totaling 107 patients (42 MIS and 65 open) with a mean age of 16 years. Overall there was no difference in curve correction between MISS (73.2%) and open (76.7%) cohorts. EBL was significantly lower in the MISS (271 ml) compared to the open (527 ml) group, but operative time was significantly longer (380 min for MISS versus 302 min for open). There were no significant differences between the approaches in pain, LOS, complications, or reoperations. Conclusion: MISS was associated with less blood loss but longer operative times compared to traditional open fusion for AIS. There was no difference in curve correction, postoperative pain, LOS, or complications/reoperations. While MISS has emerged as a feasible option for the surgical management of AIS, further research is warranted to compare these 2 approaches.

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Incidence and Radiological Risk Factors of Proximal Junctional Kyphosis in Adolescent Idiopathic Scoliosis Following Pedicle Screw Instrumentation with Rod Derotation and Direct Vertebral Rotation: A Minimum 5-Year Follow-Up Study

Journal of Clinical Medicine ◽

10.3390/jcm10225351 ◽

2021 ◽

Vol 10 (22) ◽

pp. 5351

Author(s):

Hong Jin Kim ◽

Jae Hyuk Yang ◽

Dong-Gune Chang ◽

Se-Il Suk ◽

Seung Woo Suh ◽

...

Keyword(s):

Risk Factors ◽

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Pedicle Screw ◽

Deformity Correction ◽

Vertebral Rotation ◽

Proximal Junctional Kyphosis ◽

Pedicle Screw Instrumentation ◽

Junctional Kyphosis

Several studies have reported incidence and risk factors for the development of proximal junctional kyphosis (PJK) in patients with adolescent idiopathic scoliosis (AIS). However, there is little information regarding long-term follow-up after pedicle screw instrumentation (PSI) with rod derotation (RD) and direct vertebral rotation (DVR). Sixty-nine AIS patients who underwent deformity correction using PSI with RD and DVR were retrospectively analyzed in two groups according to the occurrence of PJK, with a minimum five-year follow-up, including a non-PJK group (n = 62) and PJK group (n = 7). Radiological parameters were evaluated at preoperative, postoperative, and last follow-up. Incidence for PJK was 10.1% (7/69 patients), with a mean 9.4-year follow-up period. The thoracolumbar/lumbar curve (TL/L curve) was proportionally higher in the PJK group. The proximal compensatory curve was significantly lower in the PJK group than in the non-PJK group preoperatively (p = 0.027), postoperatively (p = 0.001), and at last follow-up (p = 0.041). The development of PJK was associated with the TL/L curve pattern, lower preoperative proximal compensatory curve, and over-correction of the proximal curve for PSI with RD and DVR. Therefore, careful evaluation of compensatory curves as well as of the main curve is important to prevent the development of PJK in the treatment of AIS.

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Large Difference between Proximal Junctional Angle and Rod Contouring Angle is a Risk Factor for Proximal Junctional Kyphosis

10.21203/rs.2.15564/v1 ◽

2019 ◽

Author(s):

Jie Wang ◽

Ningning Yang ◽

Ming Luo ◽

Ning Li ◽

Yonggang Fan ◽

...

Keyword(s):

Risk Factor ◽

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Pearson Correlation ◽

Spinal Instrumentation ◽

Proximal Junctional Kyphosis ◽

Single Institution ◽

Junctional Kyphosis

Abstract Background: There are several risk factors for proximal junctional kyphosis (PJK) in adolescent idiopathic scoliosis (AIS) surgery. Decreased rod contouring angle (RCA) has been proposed as a risk factor for PJK, but the role of difference between proximal junctional angle (PJA) and RCA (PJA-RCA) has not been fully investigated. The aim of this study was to assess the role of PJA-RCA for the development of postoperative PJK in AIS. Methods: We performed a retrospective analysis of 96 AIS patients who underwent posterior segmental spinal instrumentation and fusion between the years 2012 and 2018 (minimum 1.5-year and average 2-year follow-up) at a single institution. Each patient was measured on preoperative, postoperative and final follow-up long-cassette standing radiographs. The PJA-RCA was regarded as a new definition that reflects the match degree between proximal rod contouring and vertebra curvature, and radiographic parameters were compared between PJK and non-PJK group. Results : Among the 96 patients with a mean age of 14.00 years (± 0.82), the overall incidence of PJK was 22%. PJK group showed a significantly greater preoperative SVA (P = 0.032) and larger correction of SVA (P = 0.007) than non-PJK group. At the last follow-up, PJK patients had significantly greater LL (P = 0.046). Patients in the PJK group had significantly greater preoperative PJA-RCA than the non-PJK group (4.07±3.30 vs. 1.42±4.28, P = 0.024). However, RCA was not significantly different between two groups (3.88 ± 4.34 vs. 2.86 ± 3.36, P = 0.405). In addition, Pearson correlation coefficient showed a significant correlation between the change of SVA and the last follow-up PJA (r = -0.208, P = 0.042). Preoperative PJA-RCA and postoperative PJA-RCA demonstrated similar results which showed a strong correlation with the last follow-up PJA (r = 0.528 and r = 0.532 respectively, P < 0.000). Conclusions: As a new reflex of improper rod contouring, large PJA-RCA is a risk factor for PJK in AIS, and PJK might be a compensation mechanism rather than complication when spine is shifted and overcorrected. Keywords: adolescent idiopathic scoliosis, proximal junctional kyphosis, proximal junctional angle, rod contouring angle.

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