Comparison of surgical treatment in Lenke 5C adolescent idiopathic scoliosis: anterior dual rod versus posterior pedicle fixation surgery: a comparison of two practices.
ABSTRACT Multicenter analysis of 2 groups of patients surgically treated for Lenke 5C adolescent idiopathic scoliosis (AIS).
Compare patients with Lenke 5C scoliosis surgically treated with anterior spinal fusion with dual rod instrumentation and anterior column support with patients surgically treated with posterior release and pedicle screw instrumentation.
Treatment of single, structural, lumbar, and thoracolumbar curves in patients with AIS has been the subject of some debate. Advocates of the anterior approach assert that their technique spares posterior musculature and may save distal fusion levels, and that with dual rods and anterior column support the issues with nonunion and kyphosis have been obviated. Advocates of the posterior approach assert that with the change to posterior pedicle screw based instrumentation that correction and levels are equivalent, and the posterior approach avoids the issues with nonunion and kyphosis. This report directly compares the results of posterior versus anterior instrumented fusions in the operative treatment of adolescent idiopathic Lenke 5C curves.
We analyzed 62 patients with Lenke 5C based on radiographic and clinical data at 2 institutions: 31 patients treated with posterior, pedicle-screw instrumented fusions at 1 institution (group PSF); and 31 patients with anterior, dual-rod instrumented fusions at another institution (group ASF). Multiple clinical and radiographic parameters were evaluated and compared.
The mean age, preoperative major curve magnitude, and preoperative lowest instrumented vertebral (LIV) tilt were similar in both groups (age: PSF = 15.5 years, ASF = 15.6 years; curve size: PSF = 50.3 degrees +/- 7.0 degrees , ASF = 49.0 degrees +/- 6.6 degrees ; LIV tilt: PSF = 27.5 degrees +/- 6.5 degrees , ASF = 27.8 degrees +/- 6.2 degrees ). After surgery, the major curve corrected to an average of 6.3 degrees +/- 3.2 degrees (87.6% +/- 5.8%) in the PSF group, compared with 12.1 degrees +/- 7.4 degrees (75.7% +/- 14.8%) in the ASF group (P < 0.01). At final follow-up, the major curve measured 8.0 degrees +/- 3.0 degrees (84.2% +/- 5.8% correction) in the PSF group, compared with 15.9 degrees +/- 9.0 degrees (66.6% +/- 17.9%) in the ASF group (P = 0.01). This represented a loss of correction of 1.7 degrees +/- 1.9 degrees (3.4% +/- 3.7%) in the PSF group, and 3.8 degrees +/- 4.2 degrees (9.4% +/- 10.7%) in the ASF group (P = 0.028). The LIV tilt decreased to 4.1 degrees +/- 3.4 degrees after surgery in the PSF group, and 4.5 degrees +/- 3.7 degrees in the ASF group. At final follow-up, the LIV tilt was 5.1 degrees +/- 3.5 degrees in the PSF group, and 4.5 degrees +/- 3.7 degrees in the ASF group. EBL was identical in both groups, and length of hospital stay was significantly (P < 0.01) shorter in the PSF group (4.8 vs. 6.1 days). There were no complications in either group which extended hospital stay or required an unplanned second surgery.
At a minimum of 2-year follow-up, adolescents with Lenke 5C curves demonstrated statistically significantly better curve correction, less loss of correction over time, and shorter hospital stays when treated with a posterior release with pedicle screw instrumented fusion compared with an anterior instrumented fusion with dual rods for similar patient populations.
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ABSTRACT: Fifty-eight adults who had scoliosis or hyperlordosis had anterior arthrodesis and Zielke instrumentation. Postoperatively, the curve improved 68 per cent in forty-nine patients who had idiopathic scoliosis and 40 per cent in nine patients who had paralytic scoliosis or hyperlordosis or congenital scoliosis. More correction was obtained when a derotator apparatus was used. Only one patient had failure of the instrumentation that necessitated additional surgical treatment. All of the arthrodeses resulted in osseous fusion. No patient who had idiopathic scoliosis lost correction (average follow-up, forty-two months; range, thirty to seventy-eight months). There were no serious complications. Lumbar lordosis decreased an average of 24 per cent compared with the preoperative measurement. This decrease was thought to be related to the correction of vertebral rotation in the curve and to the surgical technique. Use of the Zielke instrumentation resulted in excellent correction, which was not lost postoperatively in the patients who had an idiopathic curve and which was associated with minimum complications.The Journal of Bone and Joint Surgery 08/1989; 71(6):898-912. · 3.23 Impact Factor
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ABSTRACT: Prospective clinical cases series. To prospectively evaluate outcomes and critically review radiographic results and complications associated with single solid rod anterior spinal fusions in adolescent idiopathic scoliosis with 2-year minimum follow-up (range, 2-6 years). Ninety consecutive patients at a single institution with thoracic (n = 43) or thoracolumbar/lumbar (n = 47) adolescent idiopathic scoliosis were treated by one of two surgeons with a similar anterior surgical technique using rib autograft, intradiscal structural (Harms) cages placed below T12, and anterior single solid rod convex compressive instrumentation. The patients were evaluated prospectively with the Scoliosis Research Society outcome instrument and upright radiographs before surgery and minimum 2-year follow-up. RESULTS (RADIOGRAPHIC): The average coronal correction of thoracic curves was from 55 degrees to 29 degrees (47%). The average correction of thoracolumbar/lumbar curves was from 50 degrees to 15 degrees (70%). In the sagittal plane, kyphosis was improved in thoracic fusions from 23 degrees to 30 degrees (T5-T12) and lordosis maintained in thoracolumbar/lumbar fusions at -58 degrees (T12-sacrum). Five patients (5.5%) developed a pseudarthrosis, four with implant failure. Three of five required a posterior fusion for a reoperation rate of 3.3%. The fourth and fifth patients were asymptomatic and appeared fused at the 2-year follow-up, with minimal loss of correction. Common risk factors for pseudarthrosis were smoking (4 of 5), weight >70 kg (4 of 5), and for thoracic pseudarthrosis, hyperkyphosis >40 degrees T5-T12 (2 of 3). RESULTS (CLINICAL OUTCOME): Scoliosis Research Society domain average scores were improved for function, pain, and self-image (P < 0.01). With the Scoliosis Research Society satisfaction domain, 88% responded that they were satisfied with their results and 89% would undergo the same treatment again. Four of five patients with pseudarthrosis did not have statistically significant lower final Scoliosis Research Society scores than those with solid fusions (93 vs. 97, P = 0.18). Anterior instrumented fusions for adolescent idiopathic scoliosis using a single solid rod had good radiographic and clinical outcomes. Consideration should be given to alternate techniques in larger adolescents (>70 kg) with thoracic hyperkyphosis (>40 degrees ), and smoking should be avoided. Poor radiographic outcomes did not correlate with final Scoliosis Research Society scores.Spine 10/2001; 26(18):1956-65. · 2.16 Impact Factor
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ABSTRACT: Thirty-nine patients (idiopathic in 26, paralytic in 11 and congenital in 2) treated by Zielke instrumentation with fusion for thoracolumbar and lumbar curvature were reviewed. The average follow-up was 34 months. The corrections of scoliosis was 76% in the adolescent idiopathic group, 59% in the adult idiopathic group and 55% in the paralytic group; rotation corrected (38%). Kyphosis was reduced from 61 degrees to 20 degrees on the average by derotating the spine using the derotator followed by placing bone graft in the anterior disc spaces. The tilt angle of the lower end vertebra in the idiopathic group and the pelvic obliquity angle in the paralytic group were corrected remarkably. Fusion rate was 92.3%. Two of three pseudarthrosis were repaired by Harrington instrumentation and fusion. One was free from symptoms. Complications were frequent, though in most cases only minor.Nippon Seikeigeka Gakkai zasshi 09/1985; 59(8):841-51.