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Intra and interobserver variability of preoperative planning for surgical instrumentation in adolescent idiopathic scoliosis

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Abstract

Surgical instrumentation planning for the correction of scoliosis involves many difficult decisions, especially with the introduction of multi-segmental and other instrumentation technologies. A preliminary study has shown a high variability in planning among a small group of surgeons. The purpose of this paper was to evaluate and analyze the selection of fusion levels and instrumentation choices among a more extended group of scoliosis surgeons. Thirty-two experienced spinal deformity surgeons were asked to provide their preferred posterior instrumentation planning for five patients with adolescent idiopathic scoliosis (AIS) using a graphical worksheet and the usual preoperative X-rays. Overall, the number of implants used ranged from 8 to 30 per patient (mean 16; SD 6): 71% of these were mono-axial screws, 20% multi-axial screws, and 9% hooks. The selected superior and inferior instrumented vertebrae varied up to six levels. The following significant groups of strategies were identified: A- “All Pedicle Screws Constructs” [N A = 103; 66%]; B- “All Hooks constructs” [N B = 5; 3%]; C- “Hybrid Constructs” [N C = 48; 31%]. A top-to-bottom attachment sequence was selected in 49% of all cases, a bottom-up in 46%, and an alternate order in 4%. A large variability in preoperative instrumentation strategy exists in AIS within an experienced group of orthopedic spine surgeons. The impact of such choices on the resulting correction is questioned and will need to be determined with adequate clinical, biomechanical, and computer simulation prospective studies.

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Acknowledgments

This research was assisted by support from the Spinal Deformity Study Group, and funded by the Natural Sciences and Engineering Research Council of Canada, the Canada Research Chair Program, and by an educational/research grant from Medtronic Sofamor Danek. Special thanks to the members of the Spinal Deformity Study Group: Drs. A. King, B. S. Richards, C. E. Johnston, C. DeWald, C. Shaffrey, C. Brown, D. J. Sucato, D. P. Roye, D. W. Polly, E. Dawson, E. Transfeldt, F. J. Schwab, H. Labelle, J. O. Sanders, J. B. Emans, J. Braun, J. Dimar, K. N. Ibrahim, K. Bridwell, L. G. Lenke, M. T. Hresko, M. Diab, P. D. Sponsseler, R. E. McCarthy, S. S. Hu, S. Berven, S. Suk-II, S. D. Glassman, S. M. Mardjetko, T. R. Kuklo, T. Lowe, V. Arlet.

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Authors and Affiliations

  1. Department of Mechanical Engineering, École Polytechnique de Montréal, Station “Centre-ville”, P.O. Box 6079, Montreal, QC, Canada, H3C 3A7

    M. Robitaille & C. E. Aubin

  2. Research Center, Sainte-Justine University Hospital Center, 3175, Côte Sainte-Catherine Road, Montreal, QC, Canada, H3T 1C5

    M. Robitaille, C. E. Aubin & H. Labelle

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  1. M. Robitaille
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  2. C. E. Aubin
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  3. H. Labelle
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Correspondence to C. E. Aubin.

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Robitaille, M., Aubin, C.E. & Labelle, H. Intra and interobserver variability of preoperative planning for surgical instrumentation in adolescent idiopathic scoliosis. Eur Spine J 16, 1604–1614 (2007). https://doi.org/10.1007/s00586-007-0431-x

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  • DOI: https://doi.org/10.1007/s00586-007-0431-x

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