[Effect of Harrington instrumentation spondylodesis on scoliotic thoracic deformity. A retrospective 5-year analysis]

Loss of apical vertebral derotation in adolescent idiopathic scoliosis: 2-year follow-up using multi-planar reconstruction computed tomography

PURPOSE

The objective of this study was to evaluate 2 years post-surgical loss of three-dimensional correction in adolescent idiopathic scoliosis (AIS) patients using multi-planar reconstruction computed tomography (CT).

METHODS

Twenty-seven AIS patients treated by segmental pedicle screw (PS) constructs were included in this study. Correction in the axial plane was evaluated using the "relative apical vertebral rotation angle" (rAVR), defined as the difference between the axial rotation angles of the upper instrumented vertebra and the apical vertebra on reconstructed axial CT images. The Cobb angle of the main curve and apical vertebral translation was measured to evaluate the coronal correction. Thoracic kyphosis was also measured for the evaluation of sagittal profile. Measurements were performed before surgery, and 1 week and 2 years after surgery. The relationships between the correction losses and skeletal maturity, and variety of spinal constructs were also evaluated.

RESULTS

The mean preoperative Cobb angle of the major curve was 59.1° ± 11.2° before and 13.0° ± 7.2° immediately after surgery. Two years later, the mean Cobb angle had increased significantly, to 15.5° ± 7.8°, with a mean correction loss of 2.5° ± 1.5° (p < 0.001). The mean preoperative rAVR of 28.5° ± 8.4° was corrected to 15.8° ± 7.8° after surgery. It had increased significantly to 18.5 ± 8.4 by 2 years after surgery, with a mean correction loss of 2.7° ± 1.0° (p < 0.001). The mean correction losses for both the Cobb angle and rAVR were significantly greater in the skeletally immature patients. The significant correlations were recognized between the correction losses and the proportion of multi-axial screws, and the materials of constructs.

CONCLUSIONS

Statistically significant loss of correction in the Cobb angle and apical vertebral axial rotation angle (AVR) were recognized 2 years after surgery using PS constructs. The correction losses, especially AVR, were more evident in the skeletally immature patients, and in patients treated with more multi-axial screws and with titanium constructs rather than with stainless constructs.

Quality of life and back pain: outcome 16.7 years after Harrington instrumentation

STUDY DESIGN

A study on the quality of life of 82 patients with idiopathic scoliosis treated with Harrington instrumentation.

OBJECTIVE

To analyze long-term health-related quality of life and low back pain an average of 16.7 years after surgery.

SUMMARY AND BACKGROUND DATA

Quality of life evaluated by self-assessment questionnaires is an accepted outcome measure of surgical procedures. The purpose of this study was to evaluate the health status with the German version of internationally accepted and psychometrically tested questionnaires.

METHODS

Quality of life was measured with the Short Form-36 health profile. Low back pain was assessed using the Roland-Morris Questionnaire. Demographic data (age, sex, follow-up time), radiographic analysis (Kings classification, Cobb angle, extension and site of fusion), and rib cage deformity were correlated with these data. Radiologic parameters were analyzed longitudinally.

RESULTS

In comparison with the age-matched healthy population, there was no significant difference in the physical Short Form-36 scale (P = 0.98). Surgically treated patients showed significantly lower scores than at baseline in the psychologic Short Form-36 scale (P = 0.005); vitality (P < 0.001), general mental health (P = 0.003), and role activities because of emotional problems (P < 0.001) were significantly different from those of the age-matched population. Sixty-five (79.3%) of the 82 patients reported no or occasional back pain in the Roland-Morris Questionnaire. Five patients (6.1%) reported chronic back pain. Neither patient age at the time of surgery (P = 0.74) nor time of follow-up (P = 0.44), type of scoliosis (P = 0.56), or extent of fusion (P = 0.12) was associated with health-related quality of life or pain. The size of the preoperative (P = 0.06) and postoperative (P = 0.12) curves and preoperative (P = 0.28) and postoperative (P = 0.7) rib cage deformities did not correlate with the data of the Short Form-36 scale and the Roland-Morris Questionnaire.

CONCLUSIONS

In comparison with the age-matched population, the long-term effect of surgery does not affect the physical quality of life. The psychologic health status is, however, significantly impaired. Neither the type of curve, the size of scoliosis, nor the rib cage deformity influences the data.