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  • 1
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    Online Resource
    Minimally Invasive Scoliosis Surgery in Lenke 5 Adolescent Idiopathic Scoliosis: A Preliminary Result
    SAGE Publications ; 2015
    In:  Global Spine Journal Vol. 5, No. 1_suppl ( 2015-05), p. s-0035-1554561-s-0035-1554561
    Details
    In: Global Spine Journal, SAGE Publications, Vol. 5, No. 1_suppl ( 2015-05), p. s-0035-1554561-s-0035-1554561
    Abstract: Minimally invasive spine surgery has been introduced in the treatment of multilevel pathology, such as adult lumbar degenerative disorders. Recently, the concept of minimally invasive scoliosis surgery (MISS) was put forward and applied to the correction of scoliosis. However, few studies have reported the utilization of MISS technique in adolescent idiopathic scoliosis (AIS). The objective of this study is to assess the outcomes of posterior MISS in Lenke 5 AIS. Patients and Methods A total of seven patients were included who underwent posterior MISS from November 2012 to July 2014. There were six females and one male, with an average age of 17 years (range, 15–18 years). The operation time and intraoperative blood loss were recorded. The following radiographic parameters were evaluated before surgery, immediately after surgery, and at the last follow-up: curve magnitude, apical vertebral translation (AVT), apical vertebral rotation (AVR), trunk shift, thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), lumbar lordosis (LL), and sagittal vertical axis (SVA). The accuracy of pedicle screw placement was assessed according to postoperative CT scans. Screw perforation  〉  2 mm of either pedicular or vertebral cortex was considered at potential risk, and medial pedicle perforation  〉  4 mm or contour of aorta was considered at high risk. Results The average operation time was 4.4 hours (range, 2.0–6.5 hours) and intraoperative blood loss was 225 mL on average (range, 100–400 mL). A total of 66 screws were inserted in the seven patients. The Cobb angle of thoracolumbar/lumbar curve was 40 to 65 degrees (mean, 46.3 degrees) before surgery. Immediately after surgery, the correction rate of main curve was 76.4% on average (range, 70.0–87.8%), and an obvious improvement was noted in terms of AVT, AVR, trunk shift, TK, and TLK. All the patients were followed up for 8.4 months (range, 3–21 months) on average. At the last follow-up, the average loss of correction of the main curve was 1.9% (range, 0–6.0%). Except the increase of SVA (from −31.1 to −7.3 mm), no obvious changes of AVT, AVR, trunk shift, TK, TLK, and LL were observed during the follow-up. According to CT evaluation, 56 screws (84.9%) were fully contained within the cortical boundaries of the pedicle, 10 screws (15.1%) breached pedicle walls whereas 5 screws (7.5%) were at potential risk. No wound infection, implant failure, and neurologic complications were found after surgery. Conclusion A minimally invasive posterior approach, although technically challenging, is a feasible and safe option for patients with Lenke 5 AIS. However, long-term data are needed before routine use.
    Type of Medium: Online Resource
    ISSN: 2192-5682 , 2192-5690
    URL: Article
    DOI: 10.1055/s-0035-1554561
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2015
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  • 2
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    Incidence and Risk Factors of Proximal Junctional Kyphosis in Surgically Treated Young Children with Scoliosis
    SAGE Publications ; 2015
    In:  Global Spine Journal Vol. 5, No. 1_suppl ( 2015-05), p. s-0035-1554363-s-0035-1554363
    Details
    In: Global Spine Journal, SAGE Publications, Vol. 5, No. 1_suppl ( 2015-05), p. s-0035-1554363-s-0035-1554363
    Abstract: Proximal junctional kyphosis (PJK) is a well-recognized postoperative phenomenon in adults and adolescents after scoliosis surgery; however, no reports have addressed the incidence, risk factors, and behavior of PJK in young children following spinal correction surgery. The objective of this study is to determine the incidence, risk factors, and behavior of PJK in young children undergoing posterior instrumented spinal fusion. Materials and Methods This study reviewed 61 consecutive young children with congenital scoliosis treated with posterior instrumented spinal fusion (≥ 4 levels) from 2009 to 2011 in our center. They were younger than 10 years at surgery and had a UIV located between TI and T11. They were followed-up for at least 2 years. PJK was defined by a proximal junctional angle greater than 10 degrees and at least 10 degrees greater than the corresponding preoperative measurement. Radiographic measurements were performed preoperatively, immediately after surgery, and at latest follow-up, including proximal junctional angle (PJA), thoracic kyphosis, lumbar lordosis, kyphosis angles at T1–UIV, and UIV–T12, as well as the matching of rod contour. Matched rod contour referred to the difference between the proximal instrumented region angle and the proximal rod curvature less than 5 degrees. Comparison was performed between patients with and without PJK. Results The average age at surgery was 5.4 years (2–10 years) and the average follow-up was 2.7 years (2–4 years). PJK developed in 11 of the 61 patients (incidence, 18%). PJK group had larger preoperative thoracic kyphosis (48.7 vs. 36.3 degrees), longer fusion levels (9.2 vs. 6.8 levels), and larger amount of kyphosis correction (20.8 vs. 11.7 degrees). In addition, proximal instrumentation failure and unmatching of rod contour were identified as risk factors significantly associated with the occurrence of PJK. In the PJK group, average PJA increased by 14.4 degrees after 3 to 6 months postoperatively and then by 2.5 degrees until final follow-up. Six patients had screw pullout at the upmost instrumented vertebra but none complained of pain or appearance problems. They received brace treatment and their PJK was resolved. Conclusion This study demonstrated that 18% of young children were observed with PJK after correction surgery for congenital scoliosis. PJK mainly occurred within 6 months postoperatively, and its risk factors included preoperative hyperkyphosis and over correction of kyphosis, proximal instrumentation failure, and unmatching of rod contour. Brace treatment served as a salvage option for PJK in young children.
    Type of Medium: Online Resource
    ISSN: 2192-5682 , 2192-5690
    URL: Article
    DOI: 10.1055/s-0035-1554363
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2015
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  • 3
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    Does Disc Wedging Contribute to the Flexibility of Thoracic Curve in Adolescent Idiopathic Scoliosis?
    SAGE Publications ; 2015
    In:  Global Spine Journal Vol. 5, No. 1_suppl ( 2015-05), p. s-0035-1554524-s-0035-1554524
    Details
    In: Global Spine Journal, SAGE Publications, Vol. 5, No. 1_suppl ( 2015-05), p. s-0035-1554524-s-0035-1554524
    Abstract: The appreciations of curve flexibility and segmental mobility in patients with adolescent idiopathic scoliosis (AIS) are important for determining structural curves, defining the safe range of correction, selecting the segment length for fusion, determining the most appropriate surgical procedure, and predicting the results of correction. However, the role of disc wedging in predicting spinal flexibility has not been well defined. The objective of this study was, therefore, to investigate the effect of disc wedging on curve flexibility and gain insight into segmental mobility by comparing disc wedging in upright and side bending radiographs in thoracic AIS. Patients and Methods This study included a total of 116 consecutive patients with AIS with main thoracic curve. According to thoracic curve flexibility index (TCFI), 56 patients with TCFI  〈  50% were assigned to group A (Stiff), and the other 60 patients with TCFI ≥ 50% were assigned to group B (Flexible). Age, curve magnitude, disc wedging, and disc wedging percentage were compared between the two groups. Segmental flexibility indices ([upright disc angle-bending disc angle]/[upright disc angle] ) were computed and compared between periapical and remote levels. Correlations were estimated using Pearson correlation coefficients. After adjustment of covariates, logistic multivariate regression analysis of independent factors for TCFI was performed. Results Significant differences with respect to the age and curve magnitude were observed between the two groups (16.33 ± 3.08 vs. 13.50 ± 1.97, p  〈  0.01 and 56.06 ± 8.34 vs. 48.60 ± 7.87 degrees). The wedging angle and wedging percentage of discs in group B were significantly higher than those in group A (21.86 ± 6.18 vs. 17.52 ± 6.37 degrees, p  〈  0.01 and 43.55% ± 8.5 vs. 26.56% ± 9.1, p  〈  0.01). There was a significant correlation between disc wedging percentage and TCFI ( r = 0.766, p = 0.001). Multivariate regression analysis showed that the disc wedging percentage was the single greatest predictor of TCFI. And the disc wedging showed symmetric periapical distribution with significant decrease (all p values  〈  0.01) for every cephalad (+) and caudad (−) level change. The apical level +1 and −1 wedged at 6.3 and 6.7 degrees (range, 3.5–10.8 degrees), respectively. We noted mean periapical flexibility indices of 41% (+1), 44% (−1), 53% (+2) and 97% (−2), which were significantly less ( p  〈  0.01) than for the group of remote levels 90% (+3), 160% (−3), 116% (+4), and 208% (−4). Conclusion Disc wedging contributes to the spinal flexibility in thoracic AIS. The average flexibility indices of the periapical discs are significantly less than that of the remote discs. These may offer useful information in the evaluation of surgical options and preoperative planning.
    Type of Medium: Online Resource
    ISSN: 2192-5682 , 2192-5690
    URL: Article
    DOI: 10.1055/s-0035-1554524
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2015
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  • 4
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    Anterior or Posterior Release for Severe Rigid Scoliosis: Which is Safer and More Effective?
    SAGE Publications ; 2015
    In:  Global Spine Journal Vol. 5, No. 1_suppl ( 2015-05), p. s-0035-1554123-s-0035-1554123
    Details
    In: Global Spine Journal, SAGE Publications, Vol. 5, No. 1_suppl ( 2015-05), p. s-0035-1554123-s-0035-1554123
    Abstract: Various correction methods have been developed to treat severe rigid scoliosis. The anterior release was performed for many years to improve the flexibility of rigid scoliosis, however, the safety and efficacy of combined anterior/posterior approach were questioned by many authors. This study aimed to evaluate the efficacy and safety of two-stage posterior surgery for severe rigid scoliosis and to determine whether posterior release is safer and more effective than anterior release. Patients and Methods A total of 27 patients undergoing the staged posterior procedure were included in P–P group and 32 patients undergoing staged anterior/posterior procedure were included in A–P group. Halo-femoral traction was used after the release procedure for both the groups. The flexibility and correction rate were evaluated to quantify the contribution of spinal release and traction to curve flexibility. Radiographic outcomes were compared between the two groups before surgery, after release and traction, immediately postoperatively, and at the last follow-up. Results Gender, release and fusion segments, duration and weight of traction, main curve magnitude, and curve type were similar between the two groups. Significant lower flexibility of main curve ( p = 0.001) and higher global kyphosis ( p  〈  0.001) was found in P–P group. For patients in the P–P group, the flexibility of major curve averaged 14.1% before surgery, which increased to 32.5% after posterior release and Halo-femoral traction ( p  〈  0.001) and showed 44.9% correction postoperatively. Compared with patients in A–P group, patients in the P–P group seemed more benefited from release and Halo-femoral traction (18.4 vs.12.9%, p = 0.021) although they had significantly more rigid scoliosis before surgery (14.1 vs. 21.0%, p  〈  0.001). Besides, the final correction rate of the main curve was similar between the two groups (50.1 vs. 44.9%, p = 0.094). Five patients in the A–P group were found to have respiratory system related complications, whereas only one patient in P–P group experienced superficial pin site infection combined with deep venous thrombosis of the left limb. Conclusion Staged posterior surgery provides a safe and effective option for the treatment of severe rigid scoliosis. And posterior release seems superior for anterior release regarding the surgical outcomes.
    Type of Medium: Online Resource
    ISSN: 2192-5682 , 2192-5690
    URL: Article
    DOI: 10.1055/s-0035-1554123
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2015
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  • 5
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    Natural Evolution of Syrinx in Patients Undergoing Posterior Correction for Scoliosis Secondary to Syringomyelia
    SAGE Publications ; 2015
    In:  Global Spine Journal Vol. 5, No. 1_suppl ( 2015-05), p. s-0035-1554366-s-0035-1554366
    Details
    In: Global Spine Journal, SAGE Publications, Vol. 5, No. 1_suppl ( 2015-05), p. s-0035-1554366-s-0035-1554366
    Abstract: While correction surgery for syringomyelia-associated scoliosis frequently results in an elongation of the spine and may potentially influence the natural history of syringomyelia, a paucity of data exists regarding the syrinx behavior in the postoperative course. This study aims to investigate the natural evolution of syrinx in patients undergoing one-stage posterior instrumented spinal fusion for treatment of scoliosis secondary to idiopathic syringomyelia (IS). Materials and Methods Twenty-two patients with IS-associated scoliosis treated with one-stage posterior correction and fusion were evaluated at a minimum of 12-month follow-up (mean, 28.5 months; range, 12–57 months). Standing anteroposterior and lateral radiographs were examined for curve pattern, primary curve magnitude, thoracic kyphosis, and postoperative correction. Preoperatively and at follow-up, T2-weighted MR images, location, configuration, and size of the syrinx cavity were systematically assessed, and significant syrinx resolution was defined as more than 20% decrease in length or maximal syrinx/cord ratio. Results The series consisted of 15 male and 7 female patients with a mean age of 19.0 years (range, 12–35 years). Postoperative percent correction of the primary curve averaged to 64.0 ± 15.7% and was well maintained (58.5 ± 11.5%) at latest evaluation. Regarding syrinx size, the maximal syrinx/cord ratio improved from 0.44 to 0.41, with an average change rate of 3.5%. Overall, 10 (45.5%) and 11 (50.0%) patients met the criteria for syrinx improvement and stabilization, and syrinx deterioration was observed only in 1 case (4.5%). Age, gender, preoperative syrinx length, and number of fused vertebra were not associated with the prognosis of syringomyelia ( p  〉  0.05), whereas a significantly greater coronal correction was found in patients harboring a collapsed syrinx than in those with syrinx deterioration or stabilization (73.9 vs. 54.6%, p = 0.001). Using Spearman correlation test, improvement rate of the maximal syrinx/cord ratio was found to be strongly related to the coronal percent correction of the primary curve (r =  − 0.547, p = 0.008). There were no neurological or other major complications related to the surgery. Conclusion For treatment of scoliosis secondary to IS in the setting of minimal neurological deficits, one-stage spinal fusion with lengthening of the vertebral column provides an effective coronal and sagittal correction without neurological complications. Following surgery, the vast majority (95.5%) of syringes shrank or remained stable, indicating that deformity correction did not exert a deleterious effect on the natural evolution of syringomyelia.
    Type of Medium: Online Resource
    ISSN: 2192-5682 , 2192-5690
    URL: Article
    DOI: 10.1055/s-0035-1554366
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2015
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  • 6
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    Surgical Outcomes of the Nondystrophic Scoliosis Secondary to Neurofibromatosis Type I versus Curve-Matched Adolescent Idiopathic Scoliosis
    SAGE Publications ; 2015
    In:  Global Spine Journal Vol. 5, No. 1_suppl ( 2015-05), p. s-0035-1554603-s-0035-1554603
    Details
    In: Global Spine Journal, SAGE Publications, Vol. 5, No. 1_suppl ( 2015-05), p. s-0035-1554603-s-0035-1554603
    Abstract: Patients with nondystrophic scoliosis caused by NF-1 mostly require surgery. Although the radiographic findings in patients with nondystrophic scoliosis secondary to NF-1 are similar to those in patients with idiopathic scoliosis, evidence-based surgical guidelines, and long-term results are not as established as those for patients with AIS. The objective of this study is to compare the surgical outcomes of nondystrophic scoliosis secondary to neurofibromatosis type I (NF-1) and curve-matched adolescent idiopathic scoliosis (AIS) to identify the feasibility of treating nondystrophic NF-1 using the same principals as AIS and seek for potential surgical improvement. Patients and Methods A total of 19 adolescent patients with nondystrophic scoliosis secondary to NF-1 and 19 curve-matched patients with AIS were recruited into the study. Preoperative immediately and 6-month postoperative, and follow-up radiological data were reviewed and analyzed. The mean age of patients with NF-1 was 14.4 ± 1.3 years compared with 15.7 ± 3.1 years of patients with AIS. The main curves were 70.1 ± 14.4 and 75.9 ± 11.3 degrees for the patients with NF-1 and AIS, respectively. The minor curves were 37.4 ± 14.2 and 39.5 ± 13.4 degrees for the patients with NF-1 and AIS, respectively. The mean follow-up durations were 33.8 months (range, 24–60 months) and 31.6 months (range, 24–41 months) for the NF-1 and AIS groups, respectively. Results After surgery, the nondystrophic NF-1 group had less main curve correction (62.3 ± 15.5 vs. 68.9 ± 13.2%, p  〈  0.001), less apical vertebral translation (AVT) correction (−20.3 vs. −22.9 mm, p = 0.019), and less trunk shift (TS) correction (−7.8 vs. −16.0 mm, p  〈  0.001). On the sagittal plane, significantly more correction of sagittal vertical axis (SVA) (−19.3 vs. −10.0 mm, p = 0.041) was noted in the nondystrophic NF-1 group. A significant trend to worse was observed in NF-1 group during the follow-up period. At the final follow-up, significantly more loss of correction (5.4 vs. −0.8 degrees, p = 0.013) of the main curve was observed in the nondystrophic NF-1 group. Conclusion Current results suggest that satisfactory short-term surgical outcomes can be achieved in both NF-1 patients with non-dystrophic scoliosis and patients with AIS while sharing the same management strategy. However, the long-term result of nondystrophic scoliosis in patients with NF-1 is not identical to that of patients with AIS. Despite all this, it is fair to suggest that applying the surgical strategy of AIS in treating nondystrophic scoliosis secondary to NF-1 should be acknowledged.
    Type of Medium: Online Resource
    ISSN: 2192-5682 , 2192-5690
    URL: Article
    DOI: 10.1055/s-0035-1554603
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2015
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  • 7
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    Lumbofemoral Angle: A Novel Sagittal Parameter Related to Quality of Life in Patients with Adult Scoliosis
    SAGE Publications ; 2015
    In:  Global Spine Journal Vol. 5, No. 1_suppl ( 2015-05), p. s-0035-1554240-s-0035-1554240
    Details
    In: Global Spine Journal, SAGE Publications, Vol. 5, No. 1_suppl ( 2015-05), p. s-0035-1554240-s-0035-1554240
    Abstract: PT and PI-LL sometimes offer limited utility in daily practice when evaluating QOL, especially in outpatient clinics with limited time and equipment facility. This study proposes a novel spinopelvic parameter, lumbofemoral angle (LFA). The purpose of this study is to analyze the correlation between LFA and health-related (HRQOL) in adult scoliosis patients. Patients and Methods A cohort of 100 asymptomatic adult volunteers and 50 patients with adult scoliosis were prospectively recruited. The following sagittal parameters including thoracic kyphosis (TK), LL, LFA, PI, PT, and sacral slope (SS) were measured on the long-cassette standing upright lateral radiographs. HRQOL measures included the VAS, ODI, and SF-36 instruments for patients with adult scoliosis. Results LFA, the novel regional lumbosacral parameter, averaged 0.68 ± 4.5 degrees in normal adults with the 95% CI value of −7 to 7 degrees. Higher intra- and interobserver intraclass correlations (ICC) and less measurement time were observed in LFA compared with PI-LL indicating that it is easy to quantitatively evaluate the regional alignment directly from X-ray films. Although LFA in patients with adult scoliosis was found to be significantly larger (11.8 ± 8.7 vs. 0.68 ± 4.5 degrees, p  〈  0.001), it showed strong correlations with the PT and PI-LL in both groups ( p  〈  0.001). Additionally, a summary of significant correlations between LFA and QOL measurements were identified ( p  〈  0.05) Conclusion LFA could be considered a novel, user-friendly sagittal parameter, strongly correlated with previously established sagittal spinopelvic parameters and HRQOL measurements. LFA showed high inter- and intraobserver reliability, faster measurement times and could be easily identified and read. Mean LFA in asymptomatic adult patients was nearly 0 degrees with 95% CI value of −7 to 7 degrees, and significantly increased in adult scoliosis patients
    Type of Medium: Online Resource
    ISSN: 2192-5682 , 2192-5690
    URL: Article
    DOI: 10.1055/s-0035-1554240
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2015
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  • 8
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    Does the Position of the Aorta Change with the Altered Body Position in Ankylosing Spondylitis Patients with Thoracolumbar Kyphosis? A Magnetic Resonance Imaging Investigation
    SAGE Publications ; 2015
    In:  Global Spine Journal Vol. 5, No. 1_suppl ( 2015-05), p. s-0035-1554245-s-0035-1554245
    Details
    In: Global Spine Journal, SAGE Publications, Vol. 5, No. 1_suppl ( 2015-05), p. s-0035-1554245-s-0035-1554245
    Abstract: Lumbar spine osteotomy has been widely adopted to correct thoracolumbar kyphosis in ankylosing spondylitis (AS) patients; however, catastrophic aortic complications may occur during the insertion of pedicle screws or the performance of osteotomy. To prevent these iatrogenic complications, it is essential to have a clear understanding of the spatial relationship between the aorta and the spine. Previous study reported that the aorta is positioned more anteromedially relative to the spine in AS patients with thoracolumbar kyphosis when compared with normal subjects. However, patients in the aforementioned study were performed computed tomographic scans in the supine position, which was different from the prone position adopted in surgery. To the best of our knowledge, no report has been published to investigate the difference in the position of the aorta relative to the vertebrae between supine and prone positions in AS patients with fixed thoracolumbar kyphosis. The objective of this study is to explore the differences in the anatomic position of the aorta relative to the spine between supine and prone positions in AS patients with thoracolumbar kyphosis. Patients and Methods From March 2013 to June 2014, 20 AS patients (19 males, 1 female) with thoracolumbar kyphosis with a mean age of 30.9 years (range, 19–46 years) were recruited into this study. Each patient received an axial MRI scan from T9 to L3 in both the supine and prone positions. The left pedicle-aorta (LtP-Ao) angle and LtP-Ao distance were measured at each level. Radiographs were analyzed to measure the global kyphosis (GK), thoracic kyphosis (TK), lumbar lordosis (LL), and the apex of the kyphotic curve was also recorded. The paired sample t-test was used to compare these parameters between different positions. Results At T9 to L3 levels, no significant difference was noted in LtP-Ao distances (43.84 vs. 44.58 mm; p = 0.054) and LtP-Ao angles (0.67 vs. 0.03 degrees; p = 0.058) for AS patients between supine and prone positions. The correlation analysis also revealed no significant correlation between shifting of the LtP-Ao angle and GK, TK, and LL at T9 to L3 levels in the prone position. Conclusion There is no significant change of the relative position between aorta and spine at T9 to L3 levels when patients change from supine to prone position. The result of this study suggested that in advanced stage of AS, the chronic inflammation may result in the firm adhesion between the aorta and anterior longitudinal ligament. Moreover, due to the reduced mobility and limited range of motion, the aorta is more vulnerable to be injured when the misplacement of pedicle screws and the stretching of the aorta occurs during surgery. Therefore, surgeons must keep this condition in mind to avoid catastrophic aortic complications.
    Type of Medium: Online Resource
    ISSN: 2192-5682 , 2192-5690
    URL: Article
    DOI: 10.1055/s-0035-1554245
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2015
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  • 9
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    Disc and Vertebral Responses in the Unfused Lumbar Curve to Selective Thoracic Fusion in Lenke 1B/1C Scoliosis
    SAGE Publications ; 2015
    In:  Global Spine Journal Vol. 5, No. 1_suppl ( 2015-05), p. s-0035-1554523-s-0035-1554523
    Details
    In: Global Spine Journal, SAGE Publications, Vol. 5, No. 1_suppl ( 2015-05), p. s-0035-1554523-s-0035-1554523
    Abstract: Several previous studies have reported spontaneous lumbar curve correction for both anterior and posterior selective fusion in patients with Lenke 1B or 1C; however, the mechanism for this phenomenon remains unclear. The objective of this study is to analyze the detailed response of compensatory lumbar curve to selective thoracic fusion in patients with adolescent idiopathic scoliosis (AIS) with Lenke 1B/1C curve. Patients and Methods This study included patients with AIS with Lenke type 1B or 1C curves treated with posterior selective thoracic fusion (LIV at L1) from 2006 to 2008 in our institution. They had a major right thoracic curve and a compensatory lumbar curve. They were followed for at least 24 months. Radiographic measurements including disc angle and vertebra tilt in the lumbar region were compared before surgery, after surgery, and at latest follow-up. Results A total of 20 patients (7 boys and 13 girls) with a mean age of 15 years were included in this study. The thoracic curve was corrected from 46 ± 7.2 degrees preoperatively to 8 ± 4.7 degrees postoperatively, and to 9 ± 5.1 degrees at the latest follow-up. The mean lumbar compensatory Cobb angle was 36 ± 6.9 degrees before surgery, spontaneously correcting to 12 ± 5.3 degrees at latest follow-up. The most significant change of vertebral tilt occurred at LIV and the L4 vertebra in the coronal plane. Change in disc angle was 6.4 ± 3.1 degrees at L1/L2, 3.2 ± 2.3 degrees at L2/L3, 1.0 ± 1.3degrees at L3/L4, −2.3 ± 1.9 degrees at L4/L5, and −0.7 ± 0.5degrees at L5/S1. L1/L2 disc ranks highest among all the discs in the contribution to correction of the lumbar curve. Conclusion LIV and the L4 vertebra have a trend to be horizontal after selective thoracic fusion. Spontaneous correction of the unfused lumbar curve relies on the compensatory changes of lumbar disc angle, which are mainly at the junctional disc right below LIV. This study suggests that the disc right below LIV assumes the greatest portion of correction force transmitting therefore is prone to degenerate earlier than normal.
    Type of Medium: Online Resource
    ISSN: 2192-5682 , 2192-5690
    URL: Article
    DOI: 10.1055/s-0035-1554523
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2015
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  • 10
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    Impact of Pedicle Screw Instrumentation with Addition of Crosslink on Growth of Spinal Canal in Young Children
    SAGE Publications ; 2015
    In:  Global Spine Journal Vol. 5, No. 1_suppl ( 2015-05), p. s-0035-1554365-s-0035-1554365
    Details
    In: Global Spine Journal, SAGE Publications, Vol. 5, No. 1_suppl ( 2015-05), p. s-0035-1554365-s-0035-1554365
    Abstract: The use of pedicle screws has been popularized in the treatment of pediatric spinal deformity. Despite many studies regarding the effect of pedicle screws on the immature spine, there is a paucity of data concerning the impact of the screw-rod-crosslink complex on the development of spinal canal in young children. The objective of this study is to determine the influence of the screw-rod-crosslink complex on the development of spinal canal. Materials and Methods This study reviewed 34 patients with congenital scoliosis (14 boys and 20 girls) who were treated with posterior-only hemivertebrectomy and pedicle-screw-based short-segment instrumentation before the age of 5 years. They were followed-up for at least 24 months. Of these patients, 10 underwent only pedicle screw instrumentation without crosslink, and 24 with additional crosslink placement. The vertebrae were divided into three regions as follows: (1) S-CL (screw-crosslink) region, in which the vertebrae were inserted with bilateral pedicle screws and two rods connected with the crosslink; (2) S (screw) region, in which the vertebrae were inserted with bilateral pedicle screws but without crosslink; (3) NS (no screws) region, which comprised vertebrae cephalad or caudal to the instrumented region. The area, anteroposterior and transverse diameters of the spinal canal were measured at all vertebrae on the postoperative and last follow-up computed tomography axial images. The instrumentation-related parameters were also measured, including the distance between the bilateral screws and the screw base angle. The changes in the above measurements were compared between each region to evaluate the instrumentation's effect on the spinal canal growth. Results The mean age at surgery was 37 ± 11 months (range, 21–57 months) and the mean follow-up was 37 ± 13 months (range, 24–68 months). In each region, the spinal canal dimensions significantly increased during the follow-up period. There was no significant difference in the spinal canal growth rate between the S and NS regions or between the S-CL and NS regions. In addition, a comparison of the S-CL and S regions regarding the changes in measurements of the instrumentation construct revealed no significant differences. Conclusion Pedicle-screw-based instrumentation does not cause retardation of the development of spinal canal in young children. Moreover, use of the crosslink added to the screw-rod instrumentation also demonstrates no negative effect on the growth of the spinal canal. Thus, the addition of the crosslink to screw-based instrumentation is recommended to increase fixation stability in growing patients, even in very young pediatric population.
    Type of Medium: Online Resource
    ISSN: 2192-5682 , 2192-5690
    URL: Article
    DOI: 10.1055/s-0035-1554365
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2015
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