Although pedicle screw instrumentation for the treatment of idiopathic scoliosis is very popular, hybrid constructs remain a safe and effective method of scoliotic curve correction. This retrospective study was undertaken to assess the outcomes of hybrid instrumentation in the treatment of idiopathic scoliosis. Forty three children underwent surgical correction for idiopathic scoliosis. Patients were evaluated at a minimum 2-year follow-up (range 2–9 years). Clinical and radiographic assessment was performed for all patients preoperatively, immediately postoperatively, one year after surgery and at the final follow up. Radiographic parameters assessed included Cobb’s angle, coronal balance, translation of the apex vertebra, kyphosis, lordosis, angle in the T10 – L2 region and sagittal balance. Idiopathic scoliosis was classified according to the King classification system. All patients underwent posterior spinal fusion using hybrid instrumentation while 6 received, prior to the posterior fusion, anterior thoracic discectomies. Postoperatively overall Cobb’s angle correction was 59.5%. At the final follow-up an average loss of the correction of 9.5% was recorded. Nevertheless, there was an overall correction of the translation of the apex vertebra and a satisfactory coronal balance improvement at the final follow up compared to the immediate postoperative follow-up. Although a trend toward improved sagittal balance was noted, it was not statistically significant. The surgical complications included 2 cases of deep wound infection. In addition one patient required revision and a longer fusion distally. Operative treatment of adolescent idiopathic scoliosis with hybrid instrumentation yields satisfactory clinical and radiological results. Therefore, it can be considered as a safe and effective method of treatment of adolescent spinal deformity

Background: Although the clinical relevance still remains unclear there is an increased interest in the incidence of proximal junctional kyphosis (PJK) following posterior spinal scoliosis surgery. Several authors suppose patients with hybrid instrumentation (cranial laminar hooks, caudal pedicle screws and sublaminar wires) to be at greater risk for developing PJK. The aim of our study was to evaluate the incidence of PJK and to determine risk factors in our series of AIS patients with hybrid instrumentation after a minimum follow up of 5 years. Methods: 60 consecutive AIS patients (56 female, 4 male, average age 16 years, range 14 to 18 years) underwent scoliosis surgery using pedicle screws caudal and laminar hooks cranial at our institution. Pre - and postoperative Cobb angle, junctional kyphosis angle, number of fused levels and upper instrumented vertebra were assessed on lateral and anteriorposterior standing long cassette radiographs after an average follow up of 8 years (range 5 to 12 years). As published by Glattes et al. proximal junction was defined as the caudal end-plate of the upper instrumented vertebra to the cranial endplate two vertebrae proximal. A Cobb angle of the proximal junction greater than 10° and at least 10° greater than preoperative was defined abnormal. Results: Average number of fused levels was 10.2 (range 8.1 to 12.3). Average Cobb angle decreased from pre-operative 65° (range 50° to 80°) to 32° (range 22° to 40°). T 4 was the upper instrumented vertebra in 30 patients, T 5 in 18 and below T 6 in 12 patients. Average Preoperative saggital PJK Cobb was 7° (range 4° to 13°). 5 patients (12%) showed abnormal proximal junctional kyphosis angel at latest follow up (average 18°, range 14 to 28°). There was no positive correlation found between upper instrumented vertebra and abnormal PJK (r. 2. = 0.01). A greater preoperative PJK angle however showed positive correlation (r. 2. = 0.8). Conclusion: Compared to literature our data show a low rate (12%) of PJK after an average follow up of 8 years. We could not find any positive correlation between upper instrumented vertebra and incidence of PJK, a preoperative increased proximal kyphosis however seems to be a risk factor for developing PJK

Scheuermann's kyphosis is a structural deformity of the thoracic or thoracolumbar spine, which can result in severe pain, neurological compromise and cosmetic dissatisfaction. Modern surgical techniques have improved correction through a posterior-only or antero-posterior approach but can result in significant morbidity. We present our results of the surgical management of severe Scheuermann's kyphosis by a single surgeon with respect to deformity correction, global balance parameters, functional outcomes and complications at latest follow-up. We included 49 patients, of which 46 had thoracic and 3 had thoracolumbar kyphosis. Surgical indications included persistent back pain, progressive deformity, neurological compromise and poor self-image. Fourty-seven patients underwent posterior-only and 2 antero-posterior spinal arthrodesis utilising Chevron-type osteotomies and hybrid instrumentation. Mean age at surgery was 16.0 years with mean postoperative follow-up of 4.5 years. Mean kyphosis corrected from 92.1o to 46.9o (p<0.001). Concomitant scoliosis was eliminated in all of the 28 affected patients. Coronal and sagittal balance was corrected in all patients. Mean blood loss was 24% total blood volume. Mean operation time was 4.3 hours with mean inpatient stay of 9 days. SRS-22 questionnaire improved from a mean preoperative score of 3.4 to 4.6 at 2 years, with high treatment satisfaction rates. Complications included one toxic septicaemia episode but otherwise no wound infections, no junctional deformity, no loss of correction and no requirement for re-operation. Posterior spinal arthrodesis with the use of hybrid instrumentation can safely achieve excellent correction of severe Scheuermann's kyphosis helping to relieve back pain, improve functional outcomes and enhance self-image

Purpose of the study. To investigate the efficacy of pedicle screw instrumentation in correcting spinal deformity in patients with quadriplegic cerebral palsy. Also to assess quality of life and functional improvement after deformity correction as perceived by the parents of our patients. Summary of Background Data. All pedicle screw constructs have been commonly used to correct adolescent idiopathic scoliosis. There is limited information on their effectiveness in treating patients with cerebral palsy and neuromuscular scoliosis. Methods. We reviewed the medical records and serial radiographs of 45 consecutive patients with quadriplegia who underwent spinal arthrodesis using pedicle screw/rod instrumentation and a standardised surgical technique (prospectively collected single surgeon's series). All patients were wheelchair bound with collapsing thoracolumbar scoliosis and pelvic obliquity. Twenty-eight patients had associated sagittal deformities. A telephone survey was performed by an independent investigator to assess parents' perception on surgical outcome. Results. Thirty-eight patients underwent posterior-only and 7 staged anteroposterior spinal arthrodesis. Mean age at surgery was 13.4 years (range 9-18.3) and mean postoperative follow-up 3.5 years (range 2.8-5). Pedicle screw instrumentation extended from T2/T3 to L5 with bilateral pelvic fixation using iliac bolts. Scoliosis was corrected from mean 82.5° to 21.4° (74.1%). Pelvic obliquity was corrected from mean 24° to 4° (83.3%). In posterior-only procedures, average blood loss was 0.8 blood volumes, ICU stay 3.5 days, and hospital stay 17.6 days. In anteroposterior procedures, average blood loss was 0.9 blood volumes, ICU stay 8.9 days, and hospital stay 27.4 days. Major complications included one deep infection and one re-operation to remove prominent implants but no deaths, no neurological deficit and no detected pseudarthrosis. Parents' survey demonstrated 100% satisfaction rate. Conclusion. Pedicle screw instrumentation can achieve excellent correction of spinopelvic deformity in quadriplegic cerebral palsy with low complication and re-operation rates and high parent satisfaction. Our study has demonstrated that spinal correction using segmental pedicle screw/rod constructs can be performed safely and with lesser major complications and reoperations compared to the traditionally used Unit rod or hybrid instrumentation. The greater degree of deformity correction and lesser rate of complications and reoperations due to non-union, prominent instrumentation or failed pelvic fixation using a pedicle screw compared to the Unit rod technique should be balanced against the increased implant cost