Selective Thoracic Fusion with Segmental Pedicle Screw Fixation for the Treatment of Thoracic Idiopathic Scoliosis: More than Five Year's Follow-Up

Object Pedicle screw fixation has been theorized to provide better correction of scoliotic deformity, but controversy over the benefits of pedicle screw–only constructs remains, and the longer-term impact of pedicle screw fixation as compared with hybrid constructs is unclear. In this study, a retrospective review of a prospectively collected database was conducted to determine the longer-term impact of pedicle screw fixation as compared with hybrid constructs in patients with adolescent idiopathic scoliosis (AIS). Methods The authors retrospectively reviewed a multicenter database of pediatric patients (ages ≤ 18) from 1995 to 2006 and identified 127 patients with Lenke Type 1–4 AIS curves with a minimum 5 years of follow-up. Patients were divided into 2 cohorts based on whether they had undergone pedicle screw fixation or fixation with hybrid constructs. Results The mean main thoracic curvature of 56.1° ± 13.0°, which corrected to 14.9° ± 9.3°, translated into a mean correction of 73% (p < 0.01). The curve was 19.4° ± 10.6° at 2-year follow-up and 20.5° ± 10.4° at 5 years. When comparing preoperative parameters between the groups, differences were noted in the magnitude of the main thoracic curve (p = 0.04), flexibility of the main thoracic curve (p = 0.02), coronal balance (p = 0.04), T2–12 kyphosis (p = 0.02), and sex (p = 0.02). The pedicle screw cohort had fewer spinal segments instrumented (p < 0.01), fewer anterior releases performed (p = 0.02), and fewer thoracoplasties performed (p < 0.01). By 5 years of follow-up, significant differences were apparent between the two cohorts with respect to upper thoracic curvature (p = 0.01), T2–12 (p = 0.02) and T5–12 (p = 0.02) kyphosis, lumbar lordosis (p < 0.01), and sagittal balance (p = 0.01). Conclusions Although some preoperative differences did exist, outcomes were comparable between hybrid and screw constructs at 2 and 5 years. However, hybrid constructs required more concurrent anterior releases and thoracoplasties to achieve similar results.

Download Full-text

Mid-term results of computer-assisted skip pedicle screw fixation for patients with Lenke type 1 and 2 adolescent idiopathic scoliosis: A minimum five-year follow-up study

Journal of Orthopaedic Science ◽

10.1016/j.jos.2017.11.011 ◽

2018 ◽

Vol 23 (2) ◽

pp. 248-252 ◽

Cited By ~ 4

Author(s):

Masashi Uehara ◽

Jun Takahashi ◽

Shota Ikegami ◽

Shugo Kuraishi ◽

Toshimasa Futatsugi ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Pedicle Screw ◽

Screw Fixation ◽

Pedicle Screw Fixation ◽

Computer Assisted ◽

Follow Up Study ◽

Mid Term Results

Download Full-text

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

Journal of Clinical Medicine ◽

10.3390/jcm9124002 ◽

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.

Download Full-text

Determination of Distal Fusion Level with Segmental Pedicle Screw Fixation in Single Thoracic Idiopathic Scoliosis

Journal of Korean Society of Spine Surgery ◽

10.4184/jkss.2002.9.2.98 ◽

2002 ◽

Vol 9 (2) ◽

pp. 98

Author(s):

Se-Il Suk ◽

Jin-Hyok Kim ◽

Sang-Min Lee ◽

Ewy-Ryong Chung ◽

Ki-Ho Nah ◽

...

Keyword(s):

Idiopathic Scoliosis ◽

Pedicle Screw ◽

Screw Fixation ◽

Pedicle Screw Fixation ◽

Fusion Level ◽

Thoracic Idiopathic Scoliosis

Download Full-text

Minimum 5-year follow-up results of skipped pedicle screw fixation for flexible idiopathic scoliosis

Journal of Neurosurgery Spine ◽

10.3171/2011.4.spine10321 ◽

2011 ◽

Vol 15 (2) ◽

pp. 146-150 ◽

Cited By ~ 39

Author(s):

Chang Ju Hwang ◽

Choon-Ki Lee ◽

Bong-Soon Chang ◽

Min-Seok Kim ◽

Jin S. Yeom ◽

...

Keyword(s):

Blood Loss ◽

Idiopathic Scoliosis ◽

Pedicle Screw ◽

Sagittal Balance ◽

Screw Fixation ◽

Operation Time ◽

Pedicle Screw Fixation ◽

Correction Loss ◽

The Mean

Object The aim of this study was to evaluate after more than 5 years the outcome of surgical treatment for flexible idiopathic scoliosis using skipped pedicle screw fixation. Methods For patients with spine curves < 90° and flexibility > 20%, pedicle screws had been inserted into every other segment on the corrective side and 2–4 screws per curve had been inserted on the supportive side. The authors analyzed the results in 57 patients, including the correction rate of coronal curvature and rotational deformity, correction loss, sagittal balance, complications, blood loss, operation time, and implant costs. Results The mean Cobb angle was 54° preoperatively and 17° immediately after surgery (69% correction). At the last follow-up, the mean Cobb angle was 18° (2% correction loss). Rotation of the apical vertebra was corrected by 50% on average and showed only a 6% correction loss at the last follow-up. None of the patients had problems in maintaining sagittal balance. An adding-on phenomenon was detected in 4 patients (7%). Twelve of 14 patients with coronal decompensation showed improvement after surgery, whereas postoperative decompensation developed in 3 patients. Four patients had implant failures, and 4 had postoperative infections. The mean blood loss during surgery was 832 ml, and the mean operation time was 167 minutes. Compared with conventional methods, the authors' method used up to 48% fewer screws. Conclusions Skipped pedicle screw fixation of flexible idiopathic scoliosis showed satisfactory results. This method has several advantages, including reduced blood loss, shorter operation time, and reduced cost.

Download Full-text