Document Detail


Selective posterior thoracic fusion by means of direct vertebral derotation in adolescent idiopathic scoliosis: effects on the sagittal alignment.
MedLine Citation:
PMID:  21380744     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The objectives of this retrospective study were to evaluate the effect of direct vertebral derotation on the sagittal alignment of the spine after selective posterior thoracic fusion for Lenke Type I adolescent idiopathic scoliosis (AIS). Preservation of the sagittal alignment has become critical in the management of spinal deformity. Better coronal and rotational corrections in posterior selective thoracic fusion for AIS have been reported with direct vertebral derotation as compared with the simple rod rotation technique. A greater lordogenic effect has been anticipated with direct vertebral derotation; however, data comparing those two techniques in terms of correction in the sagittal plane are still lacking. Standing full-spine PA and standard lateral serial X-rays of a total of 30 consecutive patients with adolescent idiopathic scoliosis treated between 2002 and 2008 at a single institution were evaluated. All the patients had Lenke Type I curves and underwent selective posterior thoracic fusion with pedicle screw instrumentation. Patients who were treated with additional osteotomies and concave or convex thoracoplasty or concomitant anterior releases were excluded. Minimum follow-up period was 24 months. Preoperative and postoperative coronal and sagittal spinal alignments in both the groups were compared. In 13 patients, the correction was achieved by means of a simple rod rotation (SRR). In 17 patients, the technique of direct vertebral derotation (DVD) was used. Scoliosis correction averaged 67 and 69%, respectively, and was similar in both groups (p > 0.05). Thoracic kyphosis and lumbar lordosis remained unchanged in the SRR group (p > 0.1). In the direct vertebral derotation group, a significant decrease of both thoracic kyphosis and lumbar lordosis of 8.1° and 11.8°, respectively, was observed (p < 0.0001). Global sagittal balance remained within normal limits in all the patients at the latest follow-up. Decrease in thoracic kyphosis and lumbar lordosis should be taken into account when using direct vertebral derotation for selective posterior thoracic fusion in AIS. In order to preserve sagittal alignment in these patients, ultra hard rods or maneuvers that pull posteriorly the concave side of the spine, thus avoiding the application of additional flattening forces should be considered.
Authors:
Kiril V Mladenov; Christiane Vaeterlein; Ralf Stuecker
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Publication Detail:
Type:  Journal Article     Date:  2011-03-06
Journal Detail:
Title:  European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society     Volume:  20     ISSN:  1432-0932     ISO Abbreviation:  Eur Spine J     Publication Date:  2011 Jul 
Date Detail:
Created Date:  2011-07-14     Completed Date:  2012-02-09     Revised Date:  2013-06-30    
Medline Journal Info:
Nlm Unique ID:  9301980     Medline TA:  Eur Spine J     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  1114-7     Citation Subset:  IM    
Affiliation:
Altona Children's Hospital, Bleickenallee 38, 22763 Hamburg, Germany. mladenow_kiril@yahoo.com
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Bone Screws
Humans
Internal Fixators
Retrospective Studies
Rotation
Scoliosis / surgery*
Spinal Fusion / instrumentation,  methods*
Thoracic Vertebrae / surgery
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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