scholarly journals Surgical management of moderate adolescent idiopathic scoliosis with a fusionless posterior dynamic deformity correction device: interim results with bridging 5–6 disc levels at 2 or more years of follow-up

2020 ◽  
Vol 32 (5) ◽  
pp. 748-754 ◽  
Author(s):  
Yizhar Floman ◽  
Ron El-Hawary ◽  
Michael A. Millgram ◽  
Baron S. Lonner ◽  
Randal R. Betz
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Deformity Correction ◽  
Successful Outcome ◽  
Inclusion Criteria ◽  
Major Curve ◽  
Curve Magnitude ◽  
The Mean

OBJECTIVEA posterior dynamic deformity correction (PDDC) system was used to correct adolescent idiopathic scoliosis (AIS) without fusion. The preliminary outcomes of bridging only 3–4 discs in patients with variable curve severity have previously been reported. This paper examines a subgroup of patients with the authors’ proposed current indications for this device who were also treated with a longer construct.METHODSInclusion criteria included a single AIS structural curve between 40° and 60°, curve flexibility ≤ 30°, PDDC spanning 5–6 levels, and minimum 2-year follow-up. A retrospective review was conducted and demographic and radiographic data were recorded. A successful outcome was defined as a curve magnitude of ≤ 30° at final follow-up. Any serious adverse events and reoperations were recorded.RESULTSTwenty-two patients who met the inclusion criteria were operated on with the PDDC in 5 medical centers. There were 19 girls and 3 boys, aged 13–17 years, with Risser grades ≥ 2. Thirteen had Lenke type 1 curves and 9 had type 5 curves. The mean preoperative curve was 47° (range 40°–55°). At a minimum of 2 years’ follow-up, the mean major curve measured 25° (46% correction, p < 0.05). In 18 (82%) of 22 patients, the mean final Cobb angle measured ≤ 30° (range 15°–30°). Trunk shift was corrected by 1.5 cm (range 0.4–4.3 cm). The mean minor curve was reduced from 27° to 17° at final follow-up (35% correction, p < 0.05). For Lenke type 1 patterns, the mean 2D thoracic kyphosis was 24° preoperatively versus 27° at final follow-up (p < 0.05), and for Lenke type 5 curves, mean lumbar lordosis was 47° preoperatively versus 42° at final follow-up (p < 0.05). The mean preoperative Scoliosis Research Society-22 questionnaire score improved from 2.74 ± 0.3 at baseline to 4.31 ± 0.4 at 2 years after surgery (p < 0.0001). The mean preoperative self-image score and satisfaction scores improved from preoperative values, while other domain scores did not change significantly. Four patients (18%) underwent revision surgery because of nut loosening (n = 2), pedicle screw backup (n = 1), and ratchet malfunction (n = 1).CONCLUSIONSIn AIS patients with a single flexible major curve up to 60°, the fusionless PDDC device achieved a satisfactory result as 82% had residual curves ≤ 30°. These findings suggest that the PDDC device may serve as an alternative to spinal fusion in select patients.

scholarly journals Higher pedicle screw density does not improve curve correction in Lenke 2 adolescent idiopathic scoliosis

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Timothy J. Skalak ◽  
Joel Gagnier ◽  
Michelle S. Caird ◽  
Frances A. Farley ◽  
Ying Li
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Thoracic Kyphosis ◽  
Curve Correction ◽  
Major Curve ◽  
Curve Magnitude ◽  
Screw Density ◽  
Implant Density ◽  
Lenke 2

Abstract Purpose Higher pedicle screw density posterior spinal fusion (PSF) constructs have not been shown to result in improved curve correction in Lenke 1 and 5 adolescent idiopathic scoliosis (AIS) but do increase cost. The purpose of this study questioned whether higher screw density constructs improved curve correction and maintenance of correction in Lenke 2 AIS. Secondary goals were to identify predictive factors for correction and postoperative magnitude of curves in Lenke 2 AIS. Methods We identified patients 11 to 17 years old who underwent primary PSF for Lenke 2 AIS between 2007 and 2017 who had minimum follow-up of 2 years. Demographic and radiographic data were collected to perform regression and elimination analysis. Results Thirty patients (21 females, 9 males) were analyzed. Average age and SD at time of surgery was 14.0 ± 1.8 years (range, 11–17 years), and median follow-up was 2.8 years (IQR 2.1–4.0 years). Implant density did not predict final postoperative curve magnitude. Predictors of final postoperative curve magnitude were sex and preoperative curve magnitude. Predictors of percentage of correction of major curve were sex and age at the time of surgery. Predictors of final postoperative thoracic kyphosis were sex and percent flexibility preop. Females had lower final postoperative major curve magnitude, a higher percent curve correction, and lower postoperative thoracic kyphosis. Conclusions Increased implant density is not predictive of postoperative curve magnitude in Lenke 2 AIS. Predictors of postoperative curve magnitude are sex and preoperative curve magnitude. Level of evidence Level III, retrospective observational

scholarly journals “Higher Pedicle Screw Density Does Not Result in Improved Curve Correction in Lenke 2 Adolescent Idiopathic Scoliosis”

2021 ◽  
Author(s):  
Timothy Skalak ◽  
Joel Gagnier ◽  
Michelle S. Caird ◽  
Frances A. Farley ◽  
Ying Li
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Thoracic Kyphosis ◽  
Curve Correction ◽  
Major Curve ◽  
Curve Magnitude ◽  
Screw Density ◽  
Implant Density ◽  
Lenke 2

Abstract Purpose: Higher pedicle screw density posterior spinal fusion (PSF) constructs have not been shown to result in improved curve correction in Lenke 1 and 5 adolescent idiopathic scoliosis (AIS) but do increase cost. The purpose of this study questioned whether higher screw density constructs improved curve correction and maintenance of correction in Lenke 2 AIS. Secondary goals were to identify predictive factors for correction and postoperative magnitude of curves in Lenke 2 AIS. Methods: We identified patients 11 to 17 years old who underwent primary PSF for Lenke 2 AIS between 2007 and 2017 who had minimum follow up of 2 years. Demographic and radiographic data were collected to perform regression and elimination analysis. Results: Thirty patients (21 Female, 9 male) were analyzed. Average age and SD at time of surgery was 14.0 ± 1.8 years (range, 11-17 years) and median follow-up was 2.8 years (IQR 2.1-4.0 years). Implant density did not predict final postoperative curve magnitude. Predictors of final postoperative curve magnitude were sex and preoperative curve magnitude. Predictors of percentage of correction of major curve were sex and age at the time of surgery. Predictors of final postoperative thoracic kyphosis were sex and percent flexibility preop. Females had lower final postoperative major curve magnitude, a higher percent curve correction, and lower postoperative thoracic kyphosis.Conclusions: Increased implant density is not predictive of postoperative curve magnitude in Lenke 2 AIS. Predictors of postoperative curve magnitude are sex and preoperative curve magnitude.Level of Evidence: Level III Retrospective Observational

Evaluation of Vertebral derotation in the correction of Adolescent Idiopathic Scoliosis

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Essam A Emara ◽  
Hossam S Taha ◽  
Walid A AbdelGhany ◽  
Ahmed H AbouZeid ◽  
Mohammad A Yusuf
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Skeletal Maturity ◽  
Operating Time ◽  
Sagittal Profile ◽  
Correction Rate ◽  
Curve Magnitude ◽  
The Mean ◽  
Flexibility Index

Abstract Background Adolescent idiopathic scoliosis (AIS) represents a complex three-dimensional deformity. The rotation of the apical vertebrae is primarily responsible for the rib hump that represents the main cosmetic problem for adolescent patients. Correcting rotational deformity and maintaining the normal sagittal profile of the spine is more important than onlycorrecting coronal deformity. Aim of the Work to evaluate the efficacy of vertebral derotation using Single Concave Rod Rotation (SCRR) maneuver in the treatment of patients with Adolescent Idiopathic Scoliosis (AIS) by clinical and radiological follow up for 1 year. Patients and Methods This prospective analysis was done on 30 patients with AIS, who underwent one stage posterior only corrective surgery with SCRR maneuver between 2016 and 2019 at Ain Shams University Hospitals in order to correct their deformities. All patients included in this study had idiopathic curve between 40 and 80 degrees, with flexibility index &lt; 50%, and their ages were between 10 and skeletal maturity. Results Compared to the results obtained by other studies using the same technique, our study included patients with relatively large curve magnitude and the lowest flexibility index, had average coronal correction rate by about 65.5% and minimal correction loss during follow up (-1°). Furthermore, our study included the largest mean preoperative RA. The axial correction rate was average (32.7%) and has the lowest complication rate and better clinical outcome and patient satisfaction among other studies that used SCRR maneuver. However, the mean operating time in our series in the present study was longer than the mean operating time in the literature. The mean amount of blood loss in our study was more than the mean amount in other studies. Conclusion Simple concave rod rotation is a good option for correction of the deformed curve in AIS. We can state that simple concave rod rotation with pedicle screw instrumentation and without the use of DVD maneuver could successfully correct both coronal and axial deformity with minimal complication. Adding DVD technique offers a better correction of apical vertebra rotation.

scholarly journals Effect of Chêneau style braces on vertebral wedging amongst individuals with adolescent idiopathic scoliosis

2021 ◽  
Vol 77 (2) ◽  
Author(s):  
Nico Tournavitis ◽  
Tuğba Kuru Çolak ◽  
Constantinos Voutsas
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Study Cohort ◽  
Inclusion Criteria ◽  
Brace Treatment ◽  
Apical Vertebra ◽  
Structural Improvement ◽  
Spinal Brace ◽  
Vertebral Wedging

Background: It is generally accepted that braces can stop curve progression but little evidence exists regarding structural improvement in the spine using spinal bracing. Our study aimed to investigate the possible structural improvements of vertebral wedging with high correction bracing.Objectives: The aim of our study was to assess whether spinal brace treatment may influence vertebral wedging in adolescent idiopathic scoliosis (AIS).Method: We reviewed our database according to the following inclusion criteria: girls with a diagnosis of AIS, Risser 0–2, age 10–14 years with Cobb angles greater than 35°. Our study cohort consisted of 27 patients fulfilling the inclusion criteria with an average brace wearing time of 16.6 h per day and Cobb angles between 36° and 79°. The target value for our study was the apical vertebra wedging, measured twice before brace treatment commenced and twice after the average follow-up period of 20.5 months of treatment.Results: The average apex wedging noted before brace wearing started was 9.8° (median: 9) and after a period of 20.5 months of brace wearing, it had reduced to an average of 5.8° (median: 4.9), (p 0.001). This would indicate a structural correction of 44%.Conclusions: Our study supports the hypothesis that spinal high correction braces improve the degree of vertebral wedging in skeletally immature girls with AIS.Clinical implications: Structural corrections of the apical vertebra seem possible when high correction asymmetric braces are used in the treatment of patients with AIS.

Influence of curve morphology and location on the efficacy of rigid conservative treatment in patients with adolescent idiopathic scoliosis

2021 ◽  
Vol 103-B (2) ◽  
pp. 373-381
Author(s):  
Patrick Strube ◽  
Maria Gunold ◽  
Tanja Müller ◽  
Mario Leimert ◽  
André Sachse ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Conservative Treatment ◽  
Idiopathic Scoliosis ◽  
Treatment Failure ◽  
Univariate Analysis ◽  
Curve Progression ◽  
Curve Correction ◽  
Major Curve ◽  
Apical Rotation ◽  
Curve Magnitude

Aims The aim of the present study was to answer the question whether curve morphology and location have an influence on rigid conservative treatment in patients with adolescent idiopathic scoliosis (AIS). Methods We retrospectively analyzed AIS in 127 patients with single and double curves who had been treated with a Chêneau brace and physiotherapeutic specific exercises (B-PSE). The inclusion criteria were the presence of structural major curves ≥ 20° and < 50° (Risser stage 0 to 2) at the time when B-PSE was initiated. The patients were divided into two groups according to the outcome of treatment: failure (curve progression to ≥ 45° or surgery) and success (curve progression < 45° and no surgery). The main curve type (MCT), curve magnitude, and length (overall, above and below the apex), apical rotation, initial curve correction, flexibility, and derotation by the brace were compared between the two groups. Results In univariate analysis treatment failure depended significantly on: 1) MCT (p = 0.008); 2) the apical rotation of the major curve before (p = 0.007) and during brace treatment (p < 0.001); 3) the initial and in-brace Cobb angles of the major (p = 0.001 and p < 0.001, respectively) and minor curves (p = 0.015 and p = 0.002); 4) major curve flexibility (p = 0.005) and the in-brace curve correction rates (major p = 0.008, minor p = 0.034); and 5) the length of the major curve (LoC) above (p < 0.001) and below (p = 0.002) the apex. Furthermore, MCT (p = 0.043, p = 0.129, and p = 0.017 in MCT comparisons), LoC (upper length p = 0.003, lower length p = 0.005), and in-brace Cobb angles (major p = 0.002, minor p = 0.027) were significant in binary logistic regression analysis. Conclusion Curve size, location, and morphology were found to influence the outcome of rigid conservative treatment of AIS. These findings may improve future brace design and patient selection for conservative treatment. Cite this article: Bone Joint J 2021;103-B(2):373–381.

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

2017 ◽  
Vol 19 (4) ◽  
pp. 472-478 ◽  
Author(s):  
Weiguo Zhu ◽  
Weixiang Sun ◽  
Leilei Xu ◽  
Xu Sun ◽  
Zhen Liu ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Minimally Invasive ◽  
Idiopathic Scoliosis ◽  
Spinal Instrumentation ◽  
Deformity Correction ◽  
Scoliosis Surgery ◽  
Open Approach ◽  
Additional Surgery ◽  
Estimated Blood Loss

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.

Nighttime bracing with the Providence thoracolumbosacral orthosis for treatment of adolescent idiopathic scoliosis: A retrospective consecutive clinical series

2018 ◽  
Vol 43 (2) ◽  
pp. 158-162 ◽  
Author(s):  
Leigh Davis ◽  
Joshua S Murphy ◽  
Kenneth A Shaw ◽  
Kaitlin Cash ◽  
Dennis P Devito ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Successful Treatment ◽  
Treatment Success ◽  
Clinical Information ◽  
Nonoperative Treatment ◽  
Consecutive Series ◽  
Curve Magnitude ◽  
Clinical Series

Background: Orthotic treatment for adolescent idiopathic scoliosis is a mainstay in nonoperative treatment to prevent progressive spinal deformity. Objective: To determine the effectiveness of the Providence orthosis in the treatment of adolescent idiopathic scoliosis. Study design: Retrospective review. Methods: Patients treated with a Providence orthosis for adolescent idiopathic scoliosis were reviewed. Inclusion criteria included the following: age of 10–18 years; curve magnitude of 25°–40°; Risser stage of 0–2; and, if female, <1 year post menarche at the time of brace initiation. Failure was defined as curve magnitudes progressing >5° or to >45° or surgery. Radiographs and clinical information were recorded and compared between treatment success and failure cohorts. Results: 56 patients (51 female and 5 male; average of 12.26 years) were identified with average of 2.21-year follow-up and a 57.1% success rate for preventing curve progression. Factors associated with successful treatment included curve apex T10 and caudal and Risser sign ⩾ 1. Multivariate analysis identified Risser ⩾ 1 and curve apex T10 and caudal as independent predictors of successful treatment. Conclusion: The Providence nighttime orthosis can be an effective treatment for adolescent idiopathic scoliosis. Curve Apex at T10 or caudal was an independent predictors of treatment success. Clinical relevance This study identifies variables associated with treatment success using the Providence nighttime orthosis in a consecutive series of adolescent idiopathic scoliosis patients. This information provides the foundation for identifying ideal patients for nighttime bracing to guide clinical treatment.

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.

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