Sagittal plane assessment of manual concave rod bending for posterior correction in adolescents with idiopathic thoracic scoliosis (Lenke 1 and 3)

Correction of double thoracic and lumbar adolescent idiopathic scoliosis: Technical note

Reported techniques for posterior correction of 3D deformity in double thoracic and lumbar curve adolescent idiopathic scoliosis require a high density of implants in the concavities. The present technical note describes separate two-stage correction of the curves without using implants in the concavities. We report a series of 20 patients. Full-spine EOS imaging was performed preoperatively, immediately postoperatively and at a minimum 2 years' follow-up, comparing thoracic Cobb angle (66°, 34° and 38°, respectively), lumbar Cobb angle (56°, 23° and 28°, respectively), thoracic kyphosis, lumbar lordosis, lumbar apical vertebral rotation (21.9°, 7.7° and 8.9°, respectively) and thoracic apical vertebral rotation (15.7°, 7.7° and 8.9°, respectively). Despite differences from the other techniques mentioned here, satisfactory results were obtained with the present technique, minimizing implant density. LEVEL OF EVIDENCE: IV.

Patient-Specific Surgical Correction of Adolescent Idiopathic Scoliosis: A Systematic Review

The restoration of sagittal alignment is fundamental to the surgical correction of adolescent idiopathic scoliosis (AIS). Despite established techniques, some patients present with inadequate postoperative thoracic kyphosis (TK), which may increase the risk of proximal junctional kyphosis (PJK) and imbalance. There is a lack of knowledge concerning the effectiveness of patient-specific rods (PSR) with measured sagittal curves in achieving a TK similar to that planned in AIS surgery, the factors influencing this congruence, and the incidence of PJK after PSR use. This is a systematic review of all types of studies reporting on the PSR surgical correction of AIS, including research articles, proceedings, and gray literature between 2013 and December 2023. From the 28,459 titles identified in the literature search, 81 were assessed for full-text reading, and 7 studies were selected. These included six cohort studies and a comparative study versus standard rods, six monocentric and one multicentric, three prospective and four retrospective studies, all with a scientific evidence level of 4 or 3. They reported a combined total of 355 AIS patients treated with PSR. The minimum follow-up was between 4 and 24 months. These studies all reported a good match between predicted and achieved TK, with the main difference ranging from 0 to 5 degrees, p > 0.05, despite the variability in surgical techniques and the rods' properties. There was no proximal junctional kyphosis, whereas the current rate from the literature is between 15 and 46% with standard rods. There are no specific complications related to PSR. The exact role of the type of implants is still unknown. The preliminary results are, therefore, encouraging and support the use of PSR in AIS surgery.