To investigate the efficacy of pedicle screw instrumentation in correcting thoracolumbar/lumbar idiopathic scoliosis in adolescent patients. Thoracolumbar/lumbar scoliosis has been traditionally treated through an anterior approach and instrumented arthrodesis with the aim to include in the fusion the Cobb-to-Cobb levels and preserve distal mobile spinal segments. Posterior instrumentation has been extensively used for thoracic or thoracic and lumbar scoliosis. In the advent of all-pedicle screw constructs there is debate on whether thoracolumbar/lumbar scoliosis is best treated through an anterior or a posterior instrumented arthrodesis.Purpose of the study
Summary of Background Data
We present the results of correcting a double or triple curve
adolescent idiopathic scoliosis using a convex segmental pedicle
screw technique. We reviewed 191 patients with a mean age at surgery of 15 years
(11 to 23.3). Pedicle screws were placed at the convexity of each
curve. Concave screws were inserted at one or two cephalad levels
and two caudal levels. The mean operating time was 183 minutes (132
to 276) and the mean blood loss 0.22% of the total blood volume
(0.08% to 0.4%). Multimodal monitoring remained stable throughout
the operation. The mean hospital stay was 6.8 days (5 to 15).Aims
Patients and Methods
Aim:. To review the use of traction x-rays under anaesthesia in Late Onset Scoliosis to correlate traction x-ray flexibility and postoperative correction using posterior nonsegmental all
The aim of this study was to report the restauration of the normal vertebral morphology and the absence of curve progression after removal the instrumentation in AIS patients that underwent posterior correction of the deformity by common all screws construct whitout fusion. A series of 36 AIS immature patients (Risser 3 or less) were include in the study. Instrumentation was removed once the maturity stage was complete (Risser 5). Curve correction was assessed at pre and postoperative, before instrumentation removal, just post removal, and more than two years after instrumentation removal. Epiphyseal vertebral growth modulation was assessed by a coronal wedging ratio (WR) at the apical level of the main curve (MC). The mean preoperative coronal Cobb was corrected from 53.7°±7.5 to 5.5º±7.5º (89.7%) at the immediate postop. After implants removal (31.0±5.8 months) the MC was 13.1º. T5–T12 kyphosis showed a significant improvement from 19.0º before curve correction to 27.1º after implants removal (p<0.05). Before surgery, WR was 0.71±0.06, and after removal WR was 0.98±0.08 (p<0.001). At the end of follow-up, the mean sagittal range of motion (ROM) of the T12-S1 segment was 51.2±21.0º. SRS-22 scores improved from 3.31±0.25 preoperatively to 3.68±0.25 at final assessment (p<0.001). In conclusion, fusionless posterior approach using a common all
Objective. The use of all
Aim:. To evaluate the effect of a stiffer rod in normalising thoracic hypokyphosis in adolescent idiopathic scoliosis (AIS). Methods:. A retrospective review of AIS cases performed at our institution was carried out. In order to reduce variability, the analysis included only Lenke 1 cases which had all
Aim:. To compare the ability of fulcrum bend and traction radiographs to predict correction of AIS using
Introduction. Traditionally correction of idiopathic paediatric scoliosis is done by hybrid fixation. This involves a judicious combination of mono-axial and poly-axial screw constructs. This has inherent perceived advantages with better deformity correction and maintaining alignment without loss of correction over time. Study design. Single centre retrospective review of prospective collected data on the radiological analysis of idiopathic paediatric scoliosis corrections. The study compared hybrid screw constructs (poly-axial & mono-axial) to all poly-axial screw constructs over 28 months. Objective. Compare loss of correction between hybrid screw construct group (HSG) and all poly-axial screw construct group (PSG). Method. Retrospective review of preoperative, post-operative and latest follow-up radiographs on the cohort of 42 consecutive patients over a period of 28 months from a single surgeon series. Results. There were 19 patients (16 females, 3 male) in HSG and 23 (18 females, 5 male) in PSG. Average age at surgery was 14 years for HSG and 15.8 years for PSG. The average baseline Cobbs angle for HSG was 64.57°and 60.79° for PSG. In the HSG, on average 11.6 levels were fused and, in the PSG, it was 11.3 level. Mean screw density for HSG was 1.54 and PSG was 1.6. Mean correction from pre-op to immediate post-op was 46.06° (70.10%) in the HS group and 41.24 degrees (67.78%) in the PS group. At the last follow-up, mean correction was 45.12° (68.0%) for the HSG and 42.43° (70.39%) for PSG. Loss of correction from post-operative radiographs to latest follow up averaged 10.05% in HSG and 3.86% for PSG. Discussion. All poly-axial screw constructs has the advantage of minimal tray inventory, simple logistics, decreased surgical time and overall better efficiency. Rod application and derotation over poly-axial screw constructs is well controlled and we found no difference in the performance of these screws during and after the procedure. Conclusion. There was no statistically significant difference in the degree or loss of correction in HSG or PSG. No difference in radiological outcomes. In poly-axial
The purpose of this study was to investigate the efficacy and fusion rates of a unilateral
RhBMP2 was used in thirty-six consecutive patients requiring interbody fusion with fifty-five levels (thirteen patients twenty levels ALIF, twelve patients seventeen levels TLIF, eleven patients eighteen levels ACDF) using anterior cervical locking plates and lumbar posterior
To compare the ability of fulcrum bend and traction radiographs to predict correction of AIS using screw only implants and to assess the fulcrum bending correction index (FBCI) with a new measurement: the traction correction index (TCI). Retrospective radiographic analysis of case series (Level IV). Radiographic correction of scoliosis based on correction rate does not take into consideration the curve flexibility. It has been suggested that fulcrum bending radiographs predict curve correction in AIS [1]. This has been questioned [2] and has been suggested that traction radiographs are more predictive in a mixed group of patients with hybrid and screw only constructs. Twenty three patients average age 15, who underwent posterior correction of scoliosis using
Purpose of the study. To compare the effectiveness of unilateral and bilateral pedicle screw techniques in correcting adolescent idiopathic scoliosis. Summary of Background Data.
Introduction: We have compared the results of
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
Introduction This in-vitro biomechanical study was undertaken to compare the multi-directional flexibility kinematics of single versus multi-level lumbar Charité reconstructions and determine the optimal biomechanical method for surgical revision – posterior instrumentation alone or circumferential spinal arthrodesis. Methods A total of seven human cadaveric lumbosacral spines (L1 to Sacrum) were utilized in this investigation and biomechanically evaluated under the following L4-L5 reconstruction conditions: 1) Intact Spine; 2) Diskectomy Alone, 3) Charité, 4) Charité + Pedicle Screws, 5) Two Level Charité (L4-S1), 6) Two Level Charité + Pedicle Screws (L4-S1), 7) Charité L4-L5 with Pedicle Screws and Femoral Ring Allograft (L5-S1) and 8) Pedicle Screws and Femoral Ring Allograft (L4-S1). Multi-directional flexibility testing utilized the Panjabi Hybrid Testing protocol, which includes pure moments for the intact condition with the overall spinal motion replicated under displacement control for subsequent reconstructions. Hence, changes in adjacent level kinematics can be obtained compared to pure moment testing strategies. Unconstrained intact moments of ±7Nm were used for axial rotation, flexion-extension and lateral bending testing, with quantification of the operative and adjacent level range of motion (ROM) and neutral zone (NZ). All data was normalized to the intact spine condition. Results In axial rotation, single and two level Charité reconstructions produced significantly more motion than
Purpose of study: There is a controversy in the surgical treatment of unstable thoracolumbar burst fractures scoring high on the Load Sharing Classification (LSC). We have been treating unstable thoracolumbar fractures with postero-lateral fusion using short segment instrumentation and in this study we investigated our complication rate. Methods and results: We retrospectively reviewed notes and radiographs of patients presenting with thoracolumbar burst fractures and stabilised with a short-segment instrumented postero-lateral fusion between 1998 and 2007. We identified 31 patients who had adequate documentation and radiographs. Twenty patients had a high (>
=7) LSC score and none of these fixations failed. Overall early and late complication rate was low (one wound infection, one dehiscence and four unrelated infections), the one metalwork failure related to infection. Fifty-five percent of patients returned to full-time work. Approximately 50% of correction of kyphosis was lost but the average kyphosis at final follow-up was 11 degrees that we thought was acceptable. Conclusion: We concluded that treating unstable burst fractures with posterior instrumented fusion alone using a
Purpose. Retrospective review of fusion rates using Grafton DBM/allografts only in AIS. Methods. Medical records of 30 consecutive patients at an average age of 19(18-24)were reviewed. All patients had segmental fixation with dual rod and
The requirements for a motion segment fusion for degenerative disc disease are relief from symptoms from a solid union with minimal damage to surrounding tissue. This is possible with the ‘Mini PLIF’ using the B Twin cages and facet screws. This procedure produces reliable relief of symptoms with a solid fusion. The use of facet screws mean that the nerve supply of the paraspinal muscles is protected. Between June 2002 and February 2006 35 patients underwent this procedure. There were 13 males and 22 females with an average age of 40 years from all walks of life. 30 patients had back and leg pain with only 5 having solely back pain. 28 patients had surgery at L5/ S1 with 4 patients at L4/5 and 3 at both. The median pre operation ODI was 53 (IQR 60–44) and at one year follow up the ODI was 24 (IQR 37–13). There were two complications of superficial infection and two pseudarthroses requiring