Evolution of the postoperative sagittal spinal profile in early-onset scoliosis: is there a difference between rib-based and spine-based growth-friendly instrumentation?

OBJECTIVEAlthough the vertical expandable prosthetic titanium rib (VEPTR) and growing rod instrumentation (GRI) encourage spinal growth via regular lengthening, they can create different results because of their different fixation patterns and mechanisms in correcting scoliosis. Previous studies have focused comparisons on coronal plane deformity with minimal attention to the sagittal profile. In this retrospective study, the authors aimed to compare the evolution of the sagittal spinal profile in early-onset scoliosis (EOS) treated with VEPTR versus GRI.METHODSThe data for 11 patients with VEPTR and 22 with GRI were reviewed. All patients had more than 2 years’ follow-up with more than 2 lengthening procedures. Radiographic measurements were performed before and after the index surgery and at the latest follow-up. The complications in both groups were recorded.RESULTSPatients in both groups had similar diagnoses, age at the index surgery, and number of lengthening procedures. The changes in the major coronal Cobb angle and T1–S1 spinal height were not significantly different between the 2 groups. Compared with the GRI group, the VEPTR group had less correction in thoracic kyphosis (23% ± 12% vs 44% ± 16%, p < 0.001) after the index surgery and experienced a greater correction loss in thoracic kyphosis (46% ± 18% vs 11% ± 8%, p < 0.001) at the latest follow-up. Although the increase in the proximal junctional angle was not significantly different (VEPTR: 7° ± 4° vs GRI: 8° ± 5°, p = 0.569), the incidence of proximal junctional kyphosis was relatively lower in the VEPTR group (VEPTR: 18.2% vs GRI: 22.7%). No significant changes in the spinopelvic parameters were observed, while the sagittal vertical axis showed a tendency toward a neutral position in both groups. The overall complication rate was higher in the VEPTR group than in the GRI group (72.7% vs 54.5%).CONCLUSIONSThe VEPTR had coronal correction and spinal growth results similar to those with GRI. In the sagittal plane, however, the VEPTR was not comparable to the GRI in controlling thoracic kyphosis. Thus, for hyperkyphotic EOS patients, GRI is recommended over VEPTR.

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Traditional Growing Rod for Early Onset Scoliosis in High Altitude Regions: a Retrospective Study

10.21203/rs.3.rs-263446/v1 ◽

2021 ◽

Author(s):

Haijun Jiang ◽

Junrui Jonathan Hai ◽

Peng Yin ◽

Qingjun Su ◽

Shiqi Zhu ◽

...

Keyword(s):

Cobb Angle ◽

High Altitude ◽

Early Onset ◽

Early Onset Scoliosis ◽

Continuous Data ◽

Sacral Slope ◽

Sagittal Vertical Axis ◽

Initial Surgery ◽

Radiographic Measurements

Abstract Background: Children with early-onset scoliosis (EOS) living in high-altitude areas have serious deformities and poor nutritional status. There are no reports on the treatment of EOS with traditional growing rods (TGRs)in children in high-altitude areas. This study aimed to analyze the outcomes of patients in high-altitude areas treated with TGRs and compare their results according to whether altitude had an effect on therapy.Methods: Between September 2007 and December 2017, 59 consecutive patients with EOS underwent systematic surgical correction using TGRs. Patients were divided into the high-altitude group(H-A group) and low-altitude group(L-A group), and differences in surgical efficacy and complications between the groups were analyzed pre- and postoperatively. Radiographic measurements included the Cobb angle, thoracic kyphosis (TK), lumbar lordosis, T1–S1range,T1–T12 range, sagittal balance, coronal balance, distance between the C7PL and sagittal vertical axis, pelvic incidence, sacral slope, and pelvic tilt, assessed preoperatively, postoperatively, and at the last follow-up. Paired or independent Student’s t-tests were used to analyze continuous data. The χ2 test was used to analyze enumeration data. Repeated measurement analysis of variance was used to compare continuous data preoperatively, postoperatively, and at the last follow-up.Results: Mean age of all patients at the initial surgery was 8.9±2.4(5–14) years; mean duration of follow-up was 51.91±25.23months.The number of surgical procedures for all patients was 234.The average interval between operations was 11.4±3.0months.The average Cobb angle was similar in both groups preoperatively and at the last follow-up(P>0.05),although it was significantly different postoperatively (P<0.05). TK was significantly different preoperatively, postoperatively, and at the last follow-up(P<0.05).T1-S1and T1-T12lengths were significantly different preoperatively (P<0.05) but not postoperatively and at the last follow-up(P>0.05). The overall rates of complications and implant-related complications did not differ significantly between the groups(P>0.05).Conclusion: Deformity in patients with EOS in high-altitude areas was more serious, and treatment using TGRs yielded a satisfactory therapeutic effect.

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Mid-term results of a modified self-growing rod technique for the treatment of early-onset scoliosis

The Bone & Joint Journal ◽

10.1302/0301-620x.102b11.bjj-2020-0412.r3 ◽

2020 ◽

Vol 102-B (11) ◽

pp. 1560-1566

Author(s):

Hossein Mehdian ◽

Sleiman Haddad ◽

Dritan Pasku ◽

Luigi Aurelio Nasto

Keyword(s):

Cerebral Palsy ◽

Cobb Angle ◽

Early Onset ◽

Early Onset Scoliosis ◽

Growth Spurt ◽

Spinal Growth ◽

Growing Rod ◽

The Mean ◽

Mid Term Results

Aims To report the mid-term results of a modified self-growing rod (SGR) technique for the treatment of idiopathic and neuromuscular early-onset scoliosis (EOS). Methods We carried out a retrospective analysis of 16 consecutive patients with EOS treated with an SGR construct at a single hospital between September 2008 and December 2014. General demographics and deformity variables (i.e. major Cobb angle, T1 to T12 length, T1 to S1 length, pelvic obliquity, shoulder obliquity, and C7 plumb line) were recorded preoperatively, and postoperatively at yearly follow-up. Complications and revision procedures were also recorded. Only patients with a minimum follow-up of five years after surgery were included. Results A total of 16 patients were included. Six patients had an idiopathic EOS while ten patients had a neuromuscular or syndromic EOS (seven spinal muscular atrophy (SMA) and three with cerebral palsy or a syndrome). Their mean ages at surgery were 7.1 years (SD 2.2) and 13.3 years (SD 2.6) respectively at final follow-up. The mean preoperative Cobb angle of the major curve was 66.1° (SD 8.5°) and had improved to 25.5° (SD 9.9°) at final follow-up. The T1 to S1 length increased from 289.7 mm (SD 24.9) before surgery to 330.6 mm (SD 30.4) immediately after surgery. The mean T1 to S1 and T1 to T12 growth after surgery were 64.1 mm (SD 19.9) and 47.4 mm (SD 18.8), respectively, thus accounting for a mean T1 to S1 and T1 to T12 spinal growth after surgery of 10.5 mm/year (SD 3.7) and 7.8 mm/year (SD 3.3), respectively. A total of six patients (five idiopathic EOS, one cerebral palsy EOS) had broken rods during their growth spurt but were uneventfully revised with a fusion procedure. No other complications were noted. Conclusion Our data show that SGR is a safe and effective technique for the treatment of EOS in nonambulatory hypotonic patients with a neuromuscular condition. Significant spinal growth can be expected after surgery and is comparable to other published techniques for EOS. While satisfactory correction of the deformity can be achieved and maintained with this technique, a high rate of rod breakage was seen in patients with an idiopathic or cerebral palsy EOS. Cite this article: Bone Joint J 2020;102-B(11):1560–1566.

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Traditional growing rod for early-onset scoliosis in high-altitude regions: a retrospective study

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02639-4 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Haijun Jiang ◽

Junrui Jonathan Hai ◽

Peng Yin ◽

Qingjun Su ◽

Shiqi Zhu ◽

...

Keyword(s):

Cobb Angle ◽

High Altitude ◽

Early Onset ◽

Repeated Measures ◽

Early Onset Scoliosis ◽

Sacral Slope ◽

Growing Rods ◽

Initial Surgery ◽

Radiographic Measurements

Abstract Background Children with early-onset scoliosis living in high-altitude areas have severe deformities and poor nutritional status. However, no reports on early-onset scoliosis treatment using traditional growing rods in such children exist. Thus, we analyzed the outcomes of traditional growing rods treatment in such patients and the effect of altitude on therapy. Methods Between September 2007 and December 2017, 59 consecutive patients with EOS underwent systematic surgical correction using traditional growing rods. They were divided into the high-altitude and low-altitude groups, and differences in surgical efficacy and complications between the groups were analyzed pre- and postoperatively. Radiographic measurements, including the Cobb angle, thoracic kyphosis, lumbar lordosis, T1–S1 and T1–T12 heights, sagittal and coronal balance, distance between C7PL and sagittal vertical axis, pelvic incidence, sacral slope, and pelvic tilt were assessed preoperatively, postoperatively, and at the last follow-up. Continuous data were analyzed using paired or independent Student’s t tests, and they were compared preoperatively, postoperatively, and at the last follow-up using a repeated measures analysis of variance. Enumerated data were analyzed using the χ2 test. Results The mean patient age at the initial surgery and mean follow-up duration were 8.9 ± 2.4(5–14) years and 51.91 ± 25.23 months, respectively. Altogether, 234 operations were conducted for all patients with an average interval between operations of 11.4 ± 3.0 months. The average Cobb angle was similar in both groups preoperatively and at the last follow-up, it was significantly different postoperatively. TK was significantly different in all three periods. T1–S1 and T1–T12 heights were significantly different only during the preoperative period. The overall rates of complications and implant-related complications did not differ significantly between the groups. Conclusions Deformity in patients with EOS in high-altitude areas was more severe, and treatment using TGRs yielded a satisfactory therapeutic effect.

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The effects of vertebral body tethering on sagittal parameters: evaluations from a 2-years follow-up

European Spine Journal ◽

10.1007/s00586-021-07076-9 ◽

2021 ◽

Author(s):

Alice Baroncini ◽

Aurelien Courvoisier ◽

Pedro Berjano ◽

Filippo Migliorini ◽

Jörg Eschweiler ◽

...

Keyword(s):

Thoracic Kyphosis ◽

Vertical Axis ◽

Sagittal Profile ◽

Sagittal Vertical Axis ◽

Lumbar Level ◽

Thoracic Level ◽

Sagittal Parameters ◽

Type 3

Abstract Introduction While the effects of VBT on coronal parameters have been investigated in various studies, this has not yet been the case for sagittal parameters. This is of particular relevance considering that VBT does not allow direct correction of the sagittal profile. Thus, we investigated the effects of VBT on sagittal parameters in patients with adolescent idiopathic scoliosis. Materials and methods Retrospective, 2-Center study. Patients who underwent VBT and presented a 2-years follow-up were included. The differences in sagittal parameters were evaluated, along with modifications of sagittal profile following Abelin-Genevois’ classification. Results Data from 86 patients were obtained. Mean Cobb angle was 52.4 ± 13.9° at thoracic level and 47.6 ± 14.3° at lumbar level before surgery, and 28.5 ± 13.6 and 26.6 ± 12.7° at the 2-year follow-up, respectively. Mean thoracic kyphosis increased from 28.3 ± 13.8 to 33 ± 13°, the lumbar lordosis (LL) was unvaried (from 47.5 ± 13.1 to 48.4 ± 13.5°), PT decreased from 9.4 ± 8.5 to 7.4 ± 6.1°, the sagittal vertical axis SVA decreased from 4.5 ± 31.4 to − 3.6 ± 27.9 mm. No kyphotic effect on LL in patients who underwent lumbar instrumentation was observed. Before surgery, 39 patients had a type 1 sagittal profile, 18 were type 2a, 14 type 2b and 15 type 3. Postoperatively, 54 were type 1, 8 were 2a, 13 were 2b and 11 were type 3. Conclusions VBT positively influences sagittal parameters and does not have a kyphotic effect on LL.

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Predictability of Coronal Curve Flexibility in Postoperative Curve Correction in Adolescent Idiopathic Scoliosis: The Effect of the Sagittal Profile

Global Spine Journal ◽

10.1177/2192568219877862 ◽

2019 ◽

Vol 10 (3) ◽

pp. 303-311 ◽

Cited By ~ 1

Author(s):

Søren Ohrt-Nissen ◽

Hideki Shigematsu ◽

Jason Pui Yin Cheung ◽

Keith D. K. Luk ◽

Dino Samartzis

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Cobb Angle ◽

Thoracic Kyphosis ◽

Clinical Decision Making ◽

Sagittal Profile ◽

Curve Correction ◽

Sagittal Vertical Axis ◽

Flexibility Index

Study Design: Retrospective cohort study. Objectives: To assess how the thoracic kyphosis affects the ability of the fulcrum bending radiograph (FBR) to predict the coronal thoracic curve correction. Methods: A retrospective study of prospectively collected data was conducted of 107 consecutive patients with thoracic adolescent idiopathic scoliosis (AIS) treated with a standard screw-fixation protocol. Radiographic variables were assessed preoperatively and at 2-year follow-up. Curve flexibility was determined based on the FBR and the Fulcrum Bending Flexibility Index (FBCI). Radiographic variables included preoperative Cobb angle, T5-T12 kyphosis, T12-S1 lordosis, sagittal vertical axis, list, T1-T12 length, truncal shift, and radiographic shoulder height. Patients were also categorized as hypo-, normo-, or hyperkyphotic. Results: Based on multivariate modeling, an increase in FBR Cobb angle and thoracic kyphosis were significantly associated with an increase in FBCI (increased mismatch between the FBR and postoperative Cobb angles) at 2-year follow-up ( P < 0.001). In patients with hyperkyphosis, a longer instrumented length existed despite similar curve size and shorter curve length than the hypo- and normokyphotic groups. Based on these findings, we developed a new predictive postoperative curve correction index, known as the Multiprofile Flexibility Index (MFI). Conclusions: Our results show that an increase in preoperative thoracic kyphosis is associated with an increased difference between the preoperative coronal curve flexibility and the postoperative coronal curve correction. Our findings broaden the understanding of curve flexibility and indicate that selection of fusion levels may need to take into consideration the sagittal profile to improve clinical decision making and optimize outcome.

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Risk Factors for Multiple Implant-Related Complications (MIRC) with Growing-Rod for Early-Onset Scoliosis

10.21203/rs.3.rs-1078273/v1 ◽

2021 ◽

Author(s):

Haijun Jiang ◽

Junrui Jonathan Hai ◽

Yong Hai ◽

Peng Yin ◽

Qingjun Su ◽

...

Keyword(s):

Risk Factors ◽

Early Onset ◽

Lumbar Lordosis ◽

Thoracic Kyphosis ◽

Multivariate Logistic Regression Analysis ◽

Early Onset Scoliosis ◽

Multivariate Logistic Regression ◽

Growing Rod ◽

Independent Risk Factors

Abstract Study design: A retrospective single center study.Objective：To identify risk factors for multiple implant-related complications with growing-rod for early-onset scoliosis.Background: High incidence of implant-related complications in the treatment of early-onset scoliosis with traditional growing rod. The risk factors for multiple implant-related complications (MIRC) have not been adequately studied.Methods: Data of 59 early-onset scoliosis patients who had been underwent growing rod surgery at Beijing Chao-yang Hospital from September 2007 to December 2017 were reviewed. All patients had complete clinical and radiographic data. Patients were divided into groups with or without MIRC. The univariate and multivariate logistic regression analysis were performed to identify the risk factors associated MIRC.Results: The average age of insertion was 8.9 years and mean follow-up was 51.91 months. 234 implantation or expansion surgeries were performed and the average operation interval was 11.4 months. A total of 60 implant-related complications occurred. Ultimately, MIRC developed in 20 (33.9%) of 59 patients. Number of surgery procedure > 3 times , follow-up time ³50 months , preoperative thoracic kyphosis > 50°, postoperative thoracic kyphosis >50°, postoperative lumbar lordosis >50°, postoperative sagittal vertical axial >40mm are potential risk factors for MIRC (P<0.1). Multivariate logistic regression analysis showed that Number of surgery procedure > 3 times, postoperative thoracic kyphosis >50°, postoperative lumbar lordosis >50°are independent risk factors for MIFRC (P<0.05), Among them, patients with postoperative thoracic kyphosis >50°had an 18.647 times higher risk of MIFRC than postoperative thoracic kyphosis angle <50°.Conclusions: Traditional growing rod in the setting of EOS has excellent clinical and radiographic outcomes but a high multiple implant-related complications. Number of surgery procedure > 3 times, postoperative thoracic kyphosis >50°, postoperative lumbar lordosis >50° are independent risk factors for MIRC.

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Traditional Growing Rod for Early-Onset Scoliosis in High Altitude Regions: A Retrospective Study

10.21203/rs.3.rs-263446/v2 ◽

2021 ◽

Author(s):

Haijun Jiang ◽

Junrui Jonathan Hai ◽

Peng Yin ◽

Qingjun Su ◽

Shiqi Zhu ◽

...

Keyword(s):

Cobb Angle ◽

High Altitude ◽

Early Onset ◽

Repeated Measures ◽

Early Onset Scoliosis ◽

Sacral Slope ◽

Sagittal Vertical Axis ◽

Growing Rods ◽

Initial Surgery

Abstract Background：Children with early-onset scoliosis living in high-altitude areas have severe deformities and poor nutritional status.However, no reports on early-onset scoliosis treatment using traditional growing rods in such children exist. Thus, we analyzed the outcomes of traditional growing rods treatment in such patients and the effect of altitude on therapy.Methods：Between September 2007 and December 2017, 59 consecutive patients with EOS underwent systematic surgical correction using traditional growing rods.They were divided into the high-altitude and low-altitude groups, and differences in surgical efficacy and complications between the groups were analyzed pre- and postoperatively.Radiographic measurements,including the Cobb angle,thoracic kyphosis, lumbar lordosis, T1–S1and T1–T12 heights,sagittal and coronal balance, distance between C7PL and sagittal vertical axis,pelvic incidence,sacral slope, and pelvic tilt were assessed preoperatively, postoperatively, and at the last follow-up. Continuous data were analyzed using paired or independent Student’s t-tests, and they were compared preoperatively, postoperatively, and at the last follow-up using a repeated measures analysis of variance. Enumerated data were analyzed using the χ2 test.Results：The mean patient ageat the initial surgery and mean follow-up duration were 8.9±2.4(5–14) years and 51.91±25.23 months, respectively.Altogether, 234 operations were conducted for all patients with an average interval between operations of 11.4±3.0months.The average Cobb angle was similar in both groups preoperatively and at the last follow-up,it was significantly different postoperatively. TK was significantly different in all three periods.T1–S1 and T1–T12 heights were significantly different only during the preoperative period. The overall rates of complications and implant-related complications did not differ significantly between the groups.Conclutions：Deformity in patients with EOS in high-altitude areas was more severe, and treatment using TGRs yielded a satisfactory therapeutic effect.

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Spring distraction system to correct early onset scoliosis: 2 year follow-up results from 24 patients

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

10.3233/shti210470 ◽

2021 ◽

Author(s):

JVC Lemans ◽

SPJ Wijdicks ◽

RM Castelein ◽

MC Kruyt

Keyword(s):

Early Onset ◽

Treatment Options ◽

Early Onset Scoliosis ◽

Segment Length ◽

Curve Correction ◽

Spinal Growth ◽

Length Increase ◽

Sagittal Parameters ◽

Growing Spine

Current surgical treatment options for Early Onset Scoliosis (EOS), with distraction- or growth-guidance systems, show limited growth and high complication rates. We developed the Spring Distraction System (SDS), which does not have to be periodically lengthened and which provides continuous corrective force to stimulate spinal growth. This study aimed to assess curve correction and maintenance, spinal growth, and complication rate following SDS treatment. All primary- and revision patients (conversion from failed other systems) with SDS and ≥2 years follow-up were included. Outcome measures were coronal Cobb angle, sagittal parameters, spinal length measurements and complications and re-operations. Radiographic parameters were compared pre-operatively, post-operatively and at latest follow-up. Spinal length increase was expressed as mm/year. Twenty-four skeletally immature EOS patients (18 primary and 6 revision cases) were included. There were 5 idiopathic, 7 congenital, 3 syndromic and 9 neuromuscular EOS patients. Mean age at implantation was 9.1 years (primary: 8.4; conversion: 11.2). Major curve improved from 60.3° to 35.3°, and was maintained at 40.6° at latest follow-up. Mean spring length increase during follow-up was 10.4mm/year. T1-S1 length increased 13.6mm/year and the instrumented segment length showed a mean increase of 0.8mm/segment/year. In total, 17 re-operations were performed. Ten re-operations were performed to treat 9 implant-related complications. In addition, 7 patients showed spinal growth that exceeded expected growth velocity; their springs were re-tensioned during a small re-operation. Spring distraction may be feasible as an alternative to current growing spine solutions. Curve correction and growth could be maintained satisfactory without the need for repetitive lengthening procedures. Complications and re-operations could not be prevented, which emphasizes the need for further improvement.

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Complications of dual growing rod with all-pedicle screw instrumentation in the treatment of early-onset scoliosis

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02267-y ◽

2021 ◽

Vol 16 (1) ◽

Cited By ~ 1

Author(s):

Mohammad Zarei ◽

Mehdi Tavakoli ◽

Ehsan Ghadimi ◽

Alireza Moharrami ◽

Ali Nili ◽

...

Keyword(s):

Pedicle Screw ◽

Early Onset ◽

Thoracic Kyphosis ◽

Spinal Instrumentation ◽

Early Onset Scoliosis ◽

Pedicle Screw Instrumentation ◽

Growing Rods ◽

Growing Rod ◽

Operative Notes

Abstract Background Treatment of early-onset scoliosis (EOS) is still a challenge to patients, families, and surgeons. Previous studies have indicated that EOS patients are at high risk for complications following growth-friendly surgery. This study was performed to evaluate the results and complications of all-pedicle screw dual growing rod instrumentation in the treatment of EOS. Methods In an IRB-approved retrospective study, we searched the electronic medical records of our institution for all patients who underwent posterior spinal instrumentation for scoliosis between March 2014 and March 2017. Patients under the age of 10 at the time of surgery who were treated with a growth-friendly technique were then selected. Patients with incomplete records and less than 2 years of follow-up were excluded. Charts, operative notes, clinic visits, and radiographs were extracted. Radiographs were reviewed, and the main curve Cobb angle, thoracic kyphosis, pelvic tilt, pelvic incidence, sacral slope, and proximal junctional angles were measured. We specifically looked for any intra-operative or post-operative complications. Statistical analysis was performed to determine the risk factors of complications. Results A total of 42 patients with a mean age of 4.8 ± 2.1 years (range, 1.5–8 years) were included in the final analysis. Patients were followed for a median of 34 months (range, 24–55). The major curve was corrected from a mean of 42.9° ± 10.7° to 28.8° ± 9.6° at the latest follow-up. Proximal junctional angles and thoracic kyphosis increased significantly during the follow-up period (both P values < 0.001). A total of 7 complications (17%) were observed. Four patients (10%) developed superficial surgical site infections, all of which resolved with antibiotics and one round of surgical debridement. Three cases (7%) of proximal junctional kyphosis (PJK) were encountered during the study period, none of which required revision surgery. Pre-operative thoracic kyphosis was the only significant risk factor for the development of PJK. Conclusions Our findings suggest that in settings without access to magnetically controlled growing rods, dual growing rods with all-pedicle screw instrumentation is still a viable treatment strategy with comparable results and complications. The most common complications are infection and PJK, with the latter being associated with a larger pre-operative thoracic kyphosis.

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Sagittal profile modifications in hybrid versus all screw technique in adolescent idiopathic scoliosis

Scientific Reports ◽

10.1038/s41598-020-79523-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Laura Scaramuzzo ◽

Antonino Zagra ◽

Giuseppe Barone ◽

Stefano Muzzi ◽

Leone Minoia ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Cobb Angle ◽

Thoracic Kyphosis ◽

Sagittal Alignment ◽

Vertical Axis ◽

Sagittal Profile ◽

Sacral Slope ◽

Sagittal Vertical Axis ◽

Lenke Classification

AbstractAim of the study was to evaluate sagittal parameters modifications, with particular interest in thoracic kyphosis, in patients affected by adolescent idiopathic scoliosis (AIS) comparing hybrid and all-screws technique. From June 2010 to September 2018, 145 patients were enrolled. Evaluation included: Lenke classification, Risser scale, coronal Cobb angle, thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS). Patients were divided in two groups (1 all-screws and 2 hybrid); a further division, in both groups, was done considering preoperative TK values. Descriptive and inferential statistical analysis was conducted. 99 patients were in group 1, 46 in group 2 (mean follow-up 3.7 years). Patients with a normo-kyphotic profile developed a little variation in TK (Δ pre–post = 2.4° versus − 2.0° respectively). Hyper-kyphotic subgroups had a tendency of restoring a good sagittal alignment. Hypo-kyphotic subgroups, patients treated with all-screw implants developed a higher increase in TK mean Cobb angle (Δ pre–post = 10°) than the hybrid subgroup (Δ pre–post = 5.4°) (p = 0.01). All-screws group showed better results in restoring sagittal alignment in all subgroups compared to hybrid groups, especially in hypo-TK subgroup, with the important advantage to give better correction on coronal plane.

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