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Barile F, Ruffilli A, Morandi Guaitoli M, Viroli G, Ialuna M, Manzetti M, Cerasoli T, Artioli E, Traversari M, Mazzotti A, Faldini C. Long-term follow-up of adolescent idiopathic scoliosis surgery with Harrington instrumentations: a systematic review and meta-analysis. Musculoskelet Surg 2024:10.1007/s12306-024-00836-y. [PMID: 38806854 DOI: 10.1007/s12306-024-00836-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 05/14/2024] [Indexed: 05/30/2024]
Abstract
PURPOSE In the 1960s, Harrington instrumentation (HRI) revolutionized the surgical treatment of adolescent idiopathic scoliosis (AIS). Despite the transition to more innovative techniques, concerns regarding its impact on sagittal alignment, associations with low back pain, and correction loss have consistently persisted. The aim of this meta-analysis is precisely to evaluate the clinical and radiological outcomes, as well as the complications of patients treated with HRI over an extended follow-up period. A systematic search of articles about AIS patients who underwent HRI and reported long-term outcomes (> 10 years) was conducted on electronic databases according to PRISMA guidelines. Data regarding radiographic and clinical outcomes were extracted and meta-analyses were performed. Eleven studies comprising 644 patients were included. The mean follow-up ranged from 10.8 to 51.7 years. Radiographic analysis revealed a decrease in the main curve Cobb angle from 60.6° to 38.3°, with a correction loss of - 9.49° between postoperative and last follow-up. Concerning sagittal parameters, preoperative thoracic kyphosis was 19.65° at last follow-up, and preoperative lumbar lordosis was 42.94°. Additional spine surgeries were required in 42% of patients. Clinical outcomes varied among studies, but overall, HRI patients showed comparable quality of life and function to controls, although a higher incidence of low back pain was reported. Patients who underwent HRI exhibited suboptimal correction of rib deformity and a flattened sagittal spinal alignment. However, they generally displayed favourable long-term functional outcomes. Despite the implant's tendency to reduce lumbar curvature, patients achieved good clinical outcomes and functional scores comparable to age-matched individuals, suggesting that disability is not an inevitable consequence of lumbar flattening.
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Affiliation(s)
- F Barile
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Via Giulio Cesare Pupilli 1, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, 40123, Bologna, Italy
| | - A Ruffilli
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Via Giulio Cesare Pupilli 1, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, 40123, Bologna, Italy
| | - M Morandi Guaitoli
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Via Giulio Cesare Pupilli 1, Bologna, Italy.
| | - G Viroli
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Via Giulio Cesare Pupilli 1, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, 40123, Bologna, Italy
| | - M Ialuna
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Via Giulio Cesare Pupilli 1, Bologna, Italy
| | - M Manzetti
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Via Giulio Cesare Pupilli 1, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, 40123, Bologna, Italy
| | - T Cerasoli
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Via Giulio Cesare Pupilli 1, Bologna, Italy
| | - E Artioli
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Via Giulio Cesare Pupilli 1, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, 40123, Bologna, Italy
| | - M Traversari
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Via Giulio Cesare Pupilli 1, Bologna, Italy
| | - A Mazzotti
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Via Giulio Cesare Pupilli 1, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, 40123, Bologna, Italy
| | - C Faldini
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Via Giulio Cesare Pupilli 1, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, 40123, Bologna, Italy
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Lonner B, Eaker L, Hoernschemeyer D, Zhang J, Wilczek A, Elliot P, Boeyer ME, Fletcher ND, Alanay A, Yilgor C, Newton P, Miyanji F. Double major curvature treated with vertebral body tethering of both curves: how do outcomes compare to posterior spinal fusion? Spine Deform 2024; 12:651-662. [PMID: 38285163 DOI: 10.1007/s43390-023-00803-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 12/09/2023] [Indexed: 01/30/2024]
Abstract
PURPOSE Vertebral body tethering (VBT) is a non-fusion alternative to posterior spinal fusion (PSF). There have been few reports on VBT of two curvatures. We aim to compare the radiographic outcomes between VBT and PSF in patients with double curvatures in which both curves were instrumented. METHODS 29 AIS patients matched by Lenke, age (± 2 years), triradiate cartilage closure status, major Cobb angle (± 8°), and T5-T12 kyphosis (± 10°). Variables were compared using Wilcoxon rank-sum tests, Student's t tests, and chi-Square. Clinical success was defined as major curve < 35°. RESULTS Group baseline demographics were similar. Major thoracic (T) curve types had significantly better major (VBT 51.5 ± 7.9° to 31.6 ± 12.0° [40%] vs. PSF 54.3 ± 7.4° to 17.4 ± 6.5° [68%]; p = 0.0002) and secondary curve correction in the PSF group. 71% of major T VBT patients were clinically successful versus 100% of PSF. Major thoracolumbar (TL) curve types experienced comparable major (VBT 52.3 ± 7.0° to 18.3 ± 11.4° (65%) vs. PSF 53.0 ± 5.2° to 23.8 ± 10.9° (56%); p = 0.2397) and secondary curve correction. 92% of major TL VBT patients were clinically successful versus 75% in the PSF group. There was no difference in T5-12 kyphosis or lumbar lordosis between groups for any curve type. There were 4 patients (13.8%) with major complications in the VBT group compared to 0 (0%) in the PSF. CONCLUSION Patients with double major AIS who underwent VBT with major T curve types had less correction than PSF; however, those with major TL curves experienced similar radiographic outcomes regardless of procedure. Complications were greater for VBT.
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Affiliation(s)
- Baron Lonner
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, Mount Sinai Spine, 5 E 98th St., New York, NY, 10029, USA.
| | - Lily Eaker
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, Mount Sinai Spine, 5 E 98th St., New York, NY, 10029, USA
| | | | - Jessica Zhang
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, Mount Sinai Spine, 5 E 98th St., New York, NY, 10029, USA
| | - Ashley Wilczek
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, Mount Sinai Spine, 5 E 98th St., New York, NY, 10029, USA
| | - Patrick Elliot
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA
| | - Melanie E Boeyer
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA
| | - Nicholas D Fletcher
- Department of Orthopaedics, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Ahmet Alanay
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Caglar Yilgor
- Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Peter Newton
- Department of Orthopaedics, Rady Children's Hospital, San Diego, CA, USA
| | - Firoz Miyanji
- Department of Orthopedics, British Columbia Children's Hospital, Vancouver, BC, Canada
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Shah SA, Kraft DB, Miyanji F. Anterior Vertebral Body Tethering: A Review of the Available Evidence. J Am Acad Orthop Surg 2024; 32:247-256. [PMID: 38271681 DOI: 10.5435/jaaos-d-23-00312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 12/17/2023] [Indexed: 01/27/2024] Open
Abstract
Idiopathic scoliosis is a complex three-dimensional deformity of the spine with anterior overgrowth (hypokyphosis), coronal curvature, and axial rotation. Scoliosis treatment in the skeletally immature spine is therapeutically challenging because of growth and was commonly limited to observation, bracing treatment, or fusion. Fusion accomplishes powerful deformity correction at the expense of future growth and mobility of the involved segments, increasing the risk of adjacent segment degeneration and intervertebral disk disease later in life. Anterior vertebral body tethering is a motion-preserving technique that exploits the Hueter-Volkmann principle by applying compression at the anterior and convex aspects of the curve to stimulate differential vertebral growth for gradual deformity reduction without fusion. The appropriate timing, curve magnitude, tensioning, growth prediction, indications, and limitations of tethering are being refined as this technique becomes more prevalent. Early outcome studies show that growth modulation with vertebral body tethering is safe, can achieve good results, and preserve motion in select patients.
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Affiliation(s)
- Suken A Shah
- From the Department of Orthopaedic Surgery, Nemours Children's Health, Wilmington, DE (Shah), the Department of Orthopaedic Surgery, MedStar Georgetown University Hospital, Washington, DC (Dr. Kraft), and the Department of Orthopaedic Surgery, British Columbia Children's Hospital, Vancouver, British Columbia, Canada (Dr. Miyanji)
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Samdani AF, Plachta SM, Pahys JM, Quinonez A, Samuel SP, Hwang SW. Results of posterior spinal fusion after failed anterior vertebral body tethering. Spine Deform 2024; 12:367-373. [PMID: 38142246 DOI: 10.1007/s43390-023-00796-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 11/18/2023] [Indexed: 12/25/2023]
Abstract
PURPOSE In patients with adolescent idiopathic scoliosis (AIS) undergoing anterior vertebral tethering (AVBT), some will subsequently require posterior spinal fusion (PSF). Limited data exist on clinical and radiographic outcomes of fusion after tether failure. METHODS 490 patients who underwent AVBT were retrospectively analyzed. Twenty patients (4.1%) subsequently underwent conversion to PSF. A control group of patients with primary PSF (no previous AVBT) was matched for comparison. Data were compared using paired t-tests and Fisher Exact Tests. RESULTS There was a significant increase in estimated blood loss (EBL) (p = 0.002), percent estimated blood volume (%EBV) (p = 0.013), operative time (p = 0.002), and increased amount of fluoroscopy (mGy) (p = 0.04) as well as number of levels fused (p = 0.02) in the AVBT conversion group compared to primary fusion. However, no difference was found in implant density (p = 0.37), blood transfusions (p = 0.11), or intraoperative neuromonitoring events (p > 0.99). Both groups attained similar thoracic and lumbar percent correction (major coronal curve angle) from pre-op to the latest follow-up (thoracic p = 0.507, lumbar p = 0.952). CONCLUSION A subset of patients with AVBT will require conversion to PSF. Although technically more challenging, revision surgery can be safely performed with similar clinical and radiographic outcomes to primary PSF. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Amer F Samdani
- Shriners Children's-Philadelphia, 3551 N Broad St, Philadelphia, PA, 19140, USA.
| | - Stephen M Plachta
- Shriners Children's-Philadelphia, 3551 N Broad St, Philadelphia, PA, 19140, USA
| | - Joshua M Pahys
- Shriners Children's-Philadelphia, 3551 N Broad St, Philadelphia, PA, 19140, USA
| | - Alejandro Quinonez
- Shriners Children's-Philadelphia, 3551 N Broad St, Philadelphia, PA, 19140, USA
| | - Solomon P Samuel
- Shriners Children's-Philadelphia, 3551 N Broad St, Philadelphia, PA, 19140, USA
| | - Stephen W Hwang
- Shriners Children's-Philadelphia, 3551 N Broad St, Philadelphia, PA, 19140, USA
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Larson AN, Marks MC, Gonzalez Sepulveda JM, Newton PO, Devlin VJ, Peat R, Tarver ME, Babalola O, Chen AL, Gebben D, Cahill P, Shah S, Samdani A, Bachmann K, Lonner B. Non-Fusion Versus Fusion Surgery in Pediatric Idiopathic Scoliosis: What Trade-Offs in Outcomes Are Acceptable for the Patient and Family? J Bone Joint Surg Am 2024; 106:2-9. [PMID: 37943944 DOI: 10.2106/jbjs.23.00503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
BACKGROUND Vertebral body tethering and other non-fusion techniques for the treatment of pediatric idiopathic scoliosis are increasing in popularity. There is limited physician consensus on this topic as the result of a paucity of published data regarding which patients most benefit from non-fusion strategies. Thus, much of the decision-making is left to patients and parents, who must select a treatment based on their goals and values and the information available from health-care providers, the internet, and social media. We sought to understand patient and family preferences regarding the attributes of fusion versus non-fusion surgery that drive these choices. METHODS Patients and families were recruited from 7 pediatric spine centers and were asked to complete a survey-based choice experiment that had been jointly developed with the U.S. Food and Drug Administration (FDA) to evaluate patient preferences. Choices between experimentally designed alternatives were analyzed to estimate the relative importance of outcomes and requirements associated with the choice options (attributes). The attributes included appearance, confidence in the planned correction, spinal motion, device failure, reoperation, and recovery period. The inclusion criteria were (1) an age of 10 to 21 years and (2) a diagnosis of adolescent idiopathic scoliosis in patients who were considering, or who had already undergone, treatment with fusion or non-fusion surgery. Preference weights were estimated from the expected changes in choice given changes in the attributes. RESULTS A total of 344 respondents (124 patients, 92 parents, and 128 parent/patient dyads) completed the survey. One hundred and seventy-three patients were enrolled prior to surgery, and 171 were enrolled after surgery. Appearance and motion were found to be the most important drivers of choice. For the entire cohort, fusion was preferred over non-fusion. For patients who were considering surgery, the most important attributes were preservation of spinal motion and appearance. CONCLUSIONS Patients and families seeking treatment for idiopathic scoliosis value appearance and preservation of spinal motion and, to a lesser extent, reoperation rates when considering fusion versus non-fusion surgery.
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Affiliation(s)
- A Noelle Larson
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | | | - Peter O Newton
- Setting Scoliosis Straight Foundation, El Cajon, California
- Division of Orthopedics, Rady Children's Hospital, San Diego, California
| | - Vincent J Devlin
- Office of Product Evaluation and Quality, Office of Health Technology-6: Orthopedic Devices, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland
| | - Raquel Peat
- Office of Product Evaluation and Quality, Office of Health Technology-6: Orthopedic Devices, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland
| | - Michelle E Tarver
- Office of Strategic Partnerships and Technology Innovation, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland
| | - Olufemi Babalola
- Office of Strategic Partnerships and Technology Innovation, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland
| | - Allen L Chen
- Office of Strategic Partnerships and Technology Innovation, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland
| | - David Gebben
- Office of Strategic Partnerships and Technology Innovation, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland
| | - Patrick Cahill
- Division of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Suken Shah
- Department of Orthopaedic Surgery, Nemours Children's Hospital, Wilmington, Delaware
| | - Amer Samdani
- Department of Pediatric Orthopedic Surgery, Shriners Children's Philadelphia, Philadelphia, Pennsylvania
| | - Keith Bachmann
- Department of Orthopedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Baron Lonner
- Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, NY
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Bazin L, Ansorge A, Vendeuvre T, Cochard B, Tabard-Fougère A, Vazquez O, De Marco G, Sarwahi V, Dayer R. Minimally Invasive Surgery for Posterior Spinal Instrumentation and Fusion in Adolescent Idiopathic Scoliosis: Current Status and Future Application. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1882. [PMID: 38136084 PMCID: PMC10742062 DOI: 10.3390/children10121882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 12/24/2023]
Abstract
The posterior minimally invasive spine surgery (MISS) approach-or the paraspinal muscle approach-for posterior spinal fusion and segmental instrumentation in adolescent idiopathic scoliosis (AIS) was first reported in 2011. It is less invasive than the traditionally used open posterior midline approach, which is associated with significant morbidity, including denervation of the paraspinal muscles, significant blood loss, and a large midline skin incision. The literature suggests that the MISS approach, though technically challenging and with a longer operative time, provides similar levels of deformity correction, lower intraoperative blood loss, shorter hospital stays, better pain outcomes, and a faster return to sports than the open posterior midline approach. Correction maintenance and fusion rates also seem to be equivalent for both approaches. This narrative review presents the results of relevant publications reporting on spinal segmental instrumentation using pedicle screws and posterior spinal fusion as part of an MISS approach. It then compares them with the results of the traditional open posterior midline approach for treating AIS. It specifically examines perioperative morbidity and radiological and clinical outcomes with a minimal follow-up length of 2 years (range 2-9 years).
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Affiliation(s)
- Ludmilla Bazin
- Division of Paediatric Orthopaedics, Faculty of Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland (O.V.)
| | - Alexandre Ansorge
- Department of Spine Surgery, Lucerne Cantonal Hospital, 6000 Lucerne, Switzerland
| | - Tanguy Vendeuvre
- Department of Orthopedic and Trauma Surgery, University Hospital of Poitiers, 86000 Poitiers, France
| | - Blaise Cochard
- Division of Paediatric Orthopaedics, Faculty of Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland (O.V.)
| | - Anne Tabard-Fougère
- Division of Paediatric Orthopaedics, Faculty of Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland (O.V.)
| | - Oscar Vazquez
- Division of Paediatric Orthopaedics, Faculty of Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland (O.V.)
| | - Giacomo De Marco
- Division of Paediatric Orthopaedics, Faculty of Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland (O.V.)
| | - Vishal Sarwahi
- Department of Pediatric Orthopedics, Cohen Children’s Medical Center, Northwell Health, New Hyde Park, New York, NY 11040, USA
| | - Romain Dayer
- Division of Paediatric Orthopaedics, Faculty of Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland (O.V.)
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Roser MJ, Askin GN, Labrom RD, Zahir SF, Izatt M, Little JP. Vertebral body tethering for idiopathic scoliosis: a systematic review and meta-analysis. Spine Deform 2023; 11:1297-1307. [PMID: 37432604 PMCID: PMC10587225 DOI: 10.1007/s43390-023-00723-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 06/17/2023] [Indexed: 07/12/2023]
Abstract
PURPOSE Vertebral body tethering (VBT) is a recent procedure to correct and reduce spinal curves in skeletally immature patients with adolescent idiopathic scoliosis (AIS). The purpose of this systematic review and meta-analysis is to determine the expected curve reduction and potential complications for adolescent patients after VBT. METHODS PubMed, Embase, Google Scholar and Cochrane databases were searched until February 2022. Records were screened against pre-defined inclusion and exclusion criteria. Data sources were prospective and retrospective studies. Demographics, mean differences in Cobb angle, surgical details and complication rates were recorded. Meta-analysis was conducted using a random-effects model. RESULTS This systematic review includes 19 studies, and the meta-analysis includes 16 of these. VBT displayed a statistically significant reduction in Cobb angle from pre-operative to final (minimum 2 years) measurements. The initial mean Cobb angle was 47.8° (CI 95% 42.9-52.7°) and decreased to 22.2° (CI 95% 19.9-24.5°). The mean difference is - 25.8° (CI 95% - 28.9-22.7) (p < 0.01). The overall complication rate was 23% (CI 95% 14.4-31.6%), the most common complication was tether breakage 21.9% (CI 95% 10.6-33.1%). The spinal fusion rate was 7.2% (CI 95% 2.3-12.1%). CONCLUSION VBT results in a significant reduction of AIS at 2 years of follow-up. Overall complication rate was relatively high although the consequences of the complications are unknown. Further research is required to explore the reasons behind the complication rate and determine the optimal timing for the procedure. VBT remains a promising new procedure that is effective at reducing scoliotic curves and preventing spinal fusion in the majority of patients. LEVEL OF EVIDENCE Systematic review of Therapeutic Studies with evidence level II-IV.
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Affiliation(s)
- Megan J. Roser
- Orthopaedics Department, Queensland Children’s Hospital, South Brisbane, Australia
- Biomechanics and Spine Research Group (BSRG), Centre for Children’s Health Research, Queensland University of Technology (QUT), Brisbane, Australia
| | - Geoffrey N. Askin
- Orthopaedics Department, Queensland Children’s Hospital, South Brisbane, Australia
- Biomechanics and Spine Research Group (BSRG), Centre for Children’s Health Research, Queensland University of Technology (QUT), Brisbane, Australia
| | - Robert D. Labrom
- Orthopaedics Department, Queensland Children’s Hospital, South Brisbane, Australia
- Biomechanics and Spine Research Group (BSRG), Centre for Children’s Health Research, Queensland University of Technology (QUT), Brisbane, Australia
| | - Syeda Farah Zahir
- Queensland Cyber Infrastructure Foundation (QCIF), Facility for Advanced Bioinformatics, The University of Queensland (UQ), Brisbane, Australia
| | - Maree Izatt
- Orthopaedics Department, Queensland Children’s Hospital, South Brisbane, Australia
- Biomechanics and Spine Research Group (BSRG), Centre for Children’s Health Research, Queensland University of Technology (QUT), Brisbane, Australia
| | - J. Paige Little
- Biomechanics and Spine Research Group (BSRG), Centre for Children’s Health Research, Queensland University of Technology (QUT), Brisbane, Australia
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LaBarge ME, Chanbour H, Waddell WH, Vickery J, Jonzzon S, Roth SG, Croft AJ, Abtahi AM, Louer CR, Martus JE, Mencio GA, Zuckerman SL, Stephens BF. Clinical and radiographic outcomes following correction of idiopathic scoliosis in adolescence vs young adulthood. Spine Deform 2023; 11:1443-1451. [PMID: 37433979 DOI: 10.1007/s43390-023-00708-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 05/13/2023] [Indexed: 07/13/2023]
Abstract
PURPOSE The natural history of adolescent idiopathic scoliosis (AIS) has been well documented, but the impact of age at the time of surgical correction is relatively understudied. In this study, we matched patients undergoing surgical correction of adult idiopathic scoliosis (AdIS) with a cohort of AIS patients to compare: (1) coronal and sagittal radiographic correction, (2) operative variables, and (3) postoperative complications. METHODS A single-institution scoliosis registry was queried for patients undergoing idiopathic scoliosis surgery from 2000-2017. INCLUSION CRITERIA patients with idiopathic scoliosis, no previous spine surgery, and 2-year follow-up. AdIS patients were matched 1:2 with AIS patients based on Lenke classification and curve characteristics. Independent sample t-test and Chi-square test was used to analyze the data. RESULTS 31 adults underwent surgical correction of idiopathic scoliosis and were matched with 62 adolescents. Mean age of adults was 26.2 ± 11.05, mean BMI was 25.6 ± 6.0, and 22 (71.0%) were female. Mean age of adolescents was 14.2 ± 1.8, mean BMI was 22.7 ± 5.7, and 41(66.7%) were female. AdIS had significantly less postoperative major Cobb correction (63.9% vs 71.3%, p = 0.006) and final major Cobb correction (60.6% vs 67.9%, p = 0.025). AdIS also had significantly greater postoperative T1PA (11.8 vs 5.8, p = 0.002). AdIS had longer operative times (p = 0.003), higher amounts of pRBCs transfused (p = 0.005), longer LOS (p = 0.016), more ICU requirement (p = 0.013), higher overall complications (p < 0.001), higher rate of pseudarthrosis (p = 0.026), and more neurologic complications (p = 0.013). CONCLUSION Adult patients undergoing surgical correction of idiopathic scoliosis had significantly worse postoperative coronal and sagittal alignment when compared with adolescent patients. Adult patients also had higher rates of complications, longer operative times, and longer hospital stays. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Matthew E LaBarge
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21St Ave S, South Tower, Suite #4200, Nashville, TN, 37232, USA
| | - Hani Chanbour
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - William H Waddell
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21St Ave S, South Tower, Suite #4200, Nashville, TN, 37232, USA
| | - Justin Vickery
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21St Ave S, South Tower, Suite #4200, Nashville, TN, 37232, USA
| | - Soren Jonzzon
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Steven G Roth
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Andrew J Croft
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21St Ave S, South Tower, Suite #4200, Nashville, TN, 37232, USA
| | - Amir M Abtahi
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21St Ave S, South Tower, Suite #4200, Nashville, TN, 37232, USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Craig R Louer
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21St Ave S, South Tower, Suite #4200, Nashville, TN, 37232, USA
| | - Jeffrey E Martus
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21St Ave S, South Tower, Suite #4200, Nashville, TN, 37232, USA
| | - Gregory A Mencio
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21St Ave S, South Tower, Suite #4200, Nashville, TN, 37232, USA
| | - Scott L Zuckerman
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21St Ave S, South Tower, Suite #4200, Nashville, TN, 37232, USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Byron F Stephens
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21St Ave S, South Tower, Suite #4200, Nashville, TN, 37232, USA.
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
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Froehlich S, Mittelmeier W, Desai B, Pandey SJ, Raddatz H, Lembcke B, Klinder A, Osmanski-Zenk K. Surgical Treatment of Adolescent Idiopathic Scoliosis with the ApiFix Minimal Invasive Dynamic Correction System-A Preliminary Report of a 24-Month Follow-Up. Life (Basel) 2023; 13:2032. [PMID: 37895414 PMCID: PMC10608253 DOI: 10.3390/life13102032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/28/2023] [Accepted: 10/06/2023] [Indexed: 10/29/2023] Open
Abstract
Adolescent idiopathic scoliosis (AIS) is a three-dimensional growth disorder. Corrective surgical procedures are the recommended treatment option for a thoracic angle exceeding 50° and a lumbar major curve of 40°. Over the past few years, dynamic growth modulation implants have been developed as alternatives to permanent fusion. The ApiFix system was designed as a 2D "posterior dynamic device" for curve correction. After implantation in a minimally invasive procedure, it uses polyaxial joints and a self-adjusting rod to preserve the degree of motion and to accommodate the patient's growth. It provides an effective method of controlling deformity and fills the gap between the conservative treatment of major curves that are >35° and the fusion procedure. The objective of the two-center cohort study was the analysis of the correction results of patients, who underwent surgical intervention with the ApiFix system. The inclusion criteria were AIS, Lenke type 1 or type 5, a major curve on bending films of ≤30°, and an angle of the major curve of between 35° and 60°. Postoperative radiograph data were obtained longitudinally for up to 24 months of follow-up and compared to preoperative (preop) values. For comparisons of the different time points, non-parametric tests (Wilcoxon) or paired t-tests for normally distributed values were used to analyze repeated measures. Overall, 36 patients (25 female and 11 male) were treated with the ApiFix system from April 2018 to October 2020. Lenke type 1 was identified in 21 (58%) cases and Lenke type 5 was identified in 15 (42%) cases. The average angle of the thoracic major curve for Lenke 1 was 43°. The preoperative lumbar major curve (Lenke 5) was determined to be 43°. Over a follow-up of 24 months, a correction of the major curve to an average of 20° was observed for Lenke 1 and that to an average of 15° was observed for Lenke 5. Lenke type 1 and type 5 showed significant changes in the major curve over the individual test intervals in the paired comparisons compared to the starting angle (Lenke 1: preop-24 months, 0.002; Lenke 5: preop-24 months, 0.043). Overall, 11 events were recorded in the follow-up period, that required revision surgery. We distinguished between repeated interventions required after reaching the maximum distraction length of the implant due to the continued growth of the patient (n = 4) and complications, such as infections or problems associated with the anchorage of the implant (n = 7). The results from the present cohort revealed a statistically significant improvement in the postoperatively measured angles of the major and minor curves in the follow-up after 24 months. Consequently, the results were comparable to those of the already established vertebral body tethering method. Alignment in AIS via dynamic correction systems in combination with a possible growth modulation has been a treatment alternative to surgical fusing procedures for more than a decade. However, the long-term corrective effect has to be validated in further studies.
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Affiliation(s)
- Susanne Froehlich
- Orthopedic Clinic and Policlinic, University Rostock Medical Center, 18057 Rostock, Germany; (W.M.); (B.L.); (A.K.); (K.O.-Z.)
| | - Wolfram Mittelmeier
- Orthopedic Clinic and Policlinic, University Rostock Medical Center, 18057 Rostock, Germany; (W.M.); (B.L.); (A.K.); (K.O.-Z.)
| | - Biren Desai
- Sana Dreifaltigkeits-Hospital Cologne, 50933 Köln, Germany
| | | | - Herbert Raddatz
- Orthopedic Clinic and Policlinic, University Rostock Medical Center, 18057 Rostock, Germany; (W.M.); (B.L.); (A.K.); (K.O.-Z.)
| | - Bjoern Lembcke
- Orthopedic Clinic and Policlinic, University Rostock Medical Center, 18057 Rostock, Germany; (W.M.); (B.L.); (A.K.); (K.O.-Z.)
| | - Annett Klinder
- Orthopedic Clinic and Policlinic, University Rostock Medical Center, 18057 Rostock, Germany; (W.M.); (B.L.); (A.K.); (K.O.-Z.)
| | - Katrin Osmanski-Zenk
- Orthopedic Clinic and Policlinic, University Rostock Medical Center, 18057 Rostock, Germany; (W.M.); (B.L.); (A.K.); (K.O.-Z.)
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