Skip to main content
SpringerLink
Log in

Posterior fusion only for thoracic adolescent idiopathic scoliosis of more than 80°: pedicle screws versus hybrid instrumentation

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

The treatment of thoracic adolescent idiopathic scoliosis (AIS) of more than 80° traditionally consisted of a combined procedure, an anterior release performed through an open thoracotomy followed by a posterior fusion. Recently, some studies have reassessed the role of posterior fusion only as treatment for severe thoracic AIS; the correction rate of the thoracic curves was comparable to most series of combined anterior and posterior surgery, with shorter surgery time and without the negative effect on pulmonary function of anterior transthoracic exposure. Compared with other studies published so far on the use of posterior fusion alone for severe thoracic AIS, the present study examines a larger group of patients (52 cases) reviewed at a longer follow-up (average 6.7 years, range 4.5–8.5 years). The aim of the study was to evaluate the clinical and radiographic outcome of surgical treatment for severe thoracic (>80°) AIS treated with posterior spinal fusion alone, and compare comprehensively the results of posterior fusion with a hybrid construct (proximal hooks and distal pedicle screws) versus a pedicle screw instrumentation. All patients (n = 52) with main thoracic AIS curves greater than 80° (Lenke type 1, 2, 3, and 4), surgically treated between 1996 and 2000 at one institution, by posterior spinal fusion either with hybrid instrumentation (PSF–H group; n = 27 patients), or with pedicle screw-only construct (PSF–S group; n = 25 patients) were reviewed. There were no differences between the two groups in terms of age, Risser’s sign, Cobb preoperative main thoracic (MT) curve magnitude (PSF–H: 92° vs. PSF–S: 88°), or flexibility on bending films (PSF–H: 27% vs. PSF–S: 25%). Statistical analysis was performed using the t test (paired and unpaired), Wilcoxon test for non-parametric paired analysis, and the Mann–Whitney test for non-parametric unpaired analysis. At the last follow-up, the PSF–S group, when compared to the PSF–H group had a final MT correction rate of 52.4 versus 44.52% (P = 0.001), with a loss of −1.9° versus −11.3° (P = 0.0005), a TL/L correction of 50 versus 43% (ns), a greater correction of the lowest instrumented vertebra translation (−1.00 vs. −0.54 cm; P = 0.04), and tilt (−19° vs. −10°; P = 0.005) on the coronal plane. There were no statistically significant differences in sagittal and global coronal alignment between the two groups (C7-S1 offset: PSF–H = 0.5 cm vs. PSF–S = 0 cm). In the hybrid series (27 patients) surgery-related complications necessitated three revision surgeries, whereas in the screw group (25 patients) one revision surgery was performed. No neurological complications or deep wound infection occurred in this series. In conclusion, posterior spinal fusion for severe thoracic AIS with pedicle screws only, when compared to hybrid construct, allowed a greater coronal correction of both main thoracic and secondary lumbar curves, less loss of the postoperative correction achieved, and fewer revision surgeries. Posterior-only fusion with pedicle screws enabled a good and stable correction of severe scoliosis. However, severe curves may be amenable to hybrid instrumentation that produced analogous results to the screws-only constructs concerning patient satisfaction; at the latest follow-up, SRS-30 and SF-36 scores did not show any statistical differences between the two groups.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Apolone G, Mosconi P, Ware JE (1997) Questionario sullo stato di salute SF-36. Guerini e Associati Milano

  2. Arlet V (2000) Anterior thoracoscopic spine release in deformity surgery: a metaanalysis and review. Eur Spine J 9:S17–S23. doi:10.1007/s005860000186

    Article  PubMed  Google Scholar 

  3. Arlet V, Jiang L, Ouellet J (2004) Is there a need for anterior release for 70–90° thoracic curves in adolescent scoliosis. Eur Spine J 13:740–745. doi:10.1007/s00586-004-0729-x

    Article  PubMed  Google Scholar 

  4. Asher MA, Min Lai S, Burton DC (2000) Further development and validation of the Scoliosis Research Society (SRS) outcomes instrument. Spine 25:2381–2386. doi:10.1097/00007632-200009150-00018

    Article  PubMed  CAS  Google Scholar 

  5. Asher M, Min Lai S, Burton D et al (2003) The reliability and concurrent validity of the Scoliosis Research Society-22 patient questionnaire for idiopathic scoliosis. Spine 28:63–69. doi:10.1097/00007632-200301010-00015

    Article  PubMed  Google Scholar 

  6. Been HD, Kalkman CJ, Traast HS, Ongerboer de Visser BW (1994) Neurologic injury after insertion of laminar hooks during Cotrel-Dubousset instrumentation. Spine 19:1402–1405. doi:10.1097/00007632-199404150-00021

    Article  PubMed  CAS  Google Scholar 

  7. Belmont PJ, Klemme WR, Dhawan A, Polly DW (2001) In vivo accuracy of thoracic pedicle screws. Spine 26:2340–2346. doi:10.1097/00007632-200111010-00010

    Article  PubMed  Google Scholar 

  8. Bradford DS (1987) Vertebral column resection. Orthop Trans 11:502

    Google Scholar 

  9. Bradford DS, Tribus CB (1997) Vertebral column resection for the treatment of rigid coronal decompensation. Spine 22:1590–1599. doi:10.1097/00007632-199707150-00013

    Article  PubMed  CAS  Google Scholar 

  10. Bullmann V, Halm HFH, Schulte T, Lerner T, Weber TP, Liljenqvist UR (2006) Combined anterior and posterior instrumentation in severe and rigid idiopathic scoliosis. Eur Spine J 15:440–448. doi:10.1007/s00586-005-1016-1

    Article  PubMed  Google Scholar 

  11. Burton DC, Asher MA, Burke SW, Sama AA, Boachie Adjei O, Huang RC et al (2003) The treatment of large (>70°) thoracic curves in patients with idiopathic scoliosis with posterior scoliosis instrumentation and arthrodesis: When anterior release is indicated? Abstract presented POSNA meeting. Amelia Isl Plant, FLA, USA

    Google Scholar 

  12. Burton DC, Sarna AA, Asher MA et al (2005) The Treatment of large (>70°) thoracic idiopathic scoliosis curves with posterior instrumentation and arthrodesis: when is anterior release indicated? Spine 30:1979–1984. doi:10.1097/01.brs.0000176196.94565.d6

    Article  PubMed  Google Scholar 

  13. Byrd JA, Scoles PV, Winter RB, Bradford DS, Lonstein JE, Moe JH (1987) Adult idiopathic scoliosis treated by anterior and posterior spinal fusion. J Bone Joint Surg Am 69:843–850

    PubMed  Google Scholar 

  14. Chang KW (2003) Cantiliver bending technique for treatment of large and rigid scoliosis. Spine 28:2452–2458. doi:10.1097/01.BRS.0000092063.63315.D5

    Article  PubMed  Google Scholar 

  15. Choi JB, Han JO, Jeong JW (2001) False aneurysm of the thoracic aorta associated with an aorto-chest wall fistula after spinal instrumentation. J Trauma 50:140–143. doi:10.1097/00005373-200101000-00029

    Article  PubMed  CAS  Google Scholar 

  16. Cobb JR (1948) Outline for the study of scoliosis. AAOS Instr Course Lect 5:261–275

    Google Scholar 

  17. Delank KS, Delank HW, Konig DP, Popken F, Furderer S, Eysel P (2005) Iatrogenic paraplegia in spinal surgery. Arch Orthop Trauma Surg 125:33–41. doi:10.1007/s00402-004-0763-5

    Article  PubMed  Google Scholar 

  18. De Giorgi G, Stella G, Becchetti S, Martucci G, Miscioscia D (1999) Cotrel-Dubousset instrumentation for the treatment of severe scoliosis. Eur Spine J 8:8–15. doi:10.1007/s005860050120

    Article  PubMed  Google Scholar 

  19. Di Silvestre M, Parisini P, Lolli F, Bakaloudis G (2007) Complications of thoracic pedicle screws in scoliosis treatment. Spine 32:1655–1661. doi:10.1097/BRS.0b013e318074d604

    Article  PubMed  Google Scholar 

  20. Dobbs MB, Lenke LG, Kim YJ, Luhmann SJ, Bridwell KH (2006) Anterior/posterior spinal instrumentation versus posterior instrumentation alone for the treatment of adolescent idiopathic scoliotic curves more than 90°. Spine 31:2386–2391. doi:10.1097/01.brs.0000238965.81013.c5

    Article  PubMed  Google Scholar 

  21. Gertzbein SD, Robbins SE (1990) Accuracy of pedicular screw placement in vivo. Spine 15:11–14. doi:10.1097/00007632-199001000-00004

    Article  PubMed  CAS  Google Scholar 

  22. Harms J (2006) Personal Comunication. 1st International Course. New Trends Spinal Surg, Bologna

    Google Scholar 

  23. Kabins MB (2004) Point of view. Spine 29:342. doi:10.1097/01.BRS.0000109984.65138.0C

    Article  Google Scholar 

  24. Kim YJ, Lenke LG, Bridwell KH, Cho YS, Riew KD (2004) Free hand pedicle screw placement in the thoracic spine: is it safe? Spine 29:333–342. doi:10.1097/01.BRS.0000109983.12113.9B (Discussion 342)

    Article  PubMed  Google Scholar 

  25. Kim YJ, Lenke LG, Bridwell KH, Kim KL, Steger-May K (2005) Pulmonary function in adolescent idiopathic scoliosis relative to the surgical procedure. J Bone Joint Surg Am 87:1534–1541. doi:10.2106/JBJS.C.00978

    Article  PubMed  Google Scholar 

  26. Korovessis P (1987) Combined VDS and Harrington instrumentation for treatment of idiopathic double major curves. Spine 12:244–250. doi:10.1097/00007632-198704000-00009

    Article  PubMed  CAS  Google Scholar 

  27. Kuklo TR, Lenke LG, O’Brien MF, Lehman RA, Polly DW, Schroeder BS (2005) Accuracy and efficacy of thoracic pedicle screws in curves more than 90°. Spine 20:222–226. doi:10.1097/01.brs.0000150482.26918.d8

    Article  Google Scholar 

  28. Lenke L, Betz R, Harms J, Bridwell KH, Clements DH, Lowe TG et al (2001) Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis. J Bone Joint Surg Am 83:1169–1181

    PubMed  Google Scholar 

  29. Lenke LG (2003) Anterior endoscopic discectomy and fusion for adolescent idiopathic scoliosis. Spine 28:S36–S43. doi:10.1097/00007632-200308011-00007

    Article  PubMed  Google Scholar 

  30. Liljienqvist UR, Halm HF, Link TM (1997) Pedicle screw instrumentation of the thoracic spine in idiopathic scoliosis. Spine 22:2239–2245. doi:10.1097/00007632-199710010-00008

    Article  Google Scholar 

  31. Liljenqvist UR, Lepsien U, Hackeberg L, Niemeyer T, Halm H (2002) Comparative analysis of pedicle screw and hook instrumentation in posterior correction and fusion of idiopathic thoracic scoliosis. Eur Spine J 11:336–343. doi:10.1007/s00586-002-0415-9

    Article  PubMed  CAS  Google Scholar 

  32. Liljenqvist UR, Allkemper T, Hackenberg L, Link TM, Steinbeck J, Halm HFH (2002) Analysis of vertebral morphology in idiopathic scoliosis with use of magnetic resonance imaging and multiplanar reconstruction. J Bone Joint Surg Am 84:359–368

    PubMed  Google Scholar 

  33. Luhmann SJ, Lenke LG, Kim YJ, Bridwell KH, Schootman M (2005) Thoracic adolescent idiopathic scoliosis curves between 70° and 100°. Is anterior release necessary? Spine 30:2061–2067. doi:10.1097/01.brs.0000179299.78791.96

    Article  PubMed  Google Scholar 

  34. Minor ME, Morrissey NJ, Peress R, Carroccio A, Ellozy S, Agarwal G et al (2004) Endovascular treatment of an iatrogenic thoracic aortic injury after spinal instrumentation: case report. J Vasc Surg 39:893–896. doi:10.1016/j.jvs.2003.10.056

    Article  PubMed  Google Scholar 

  35. Mulholland RC (1994) Editorial. Pedicle screw fixation in the spine. J Bone Joint Surg 76:517

    CAS  Google Scholar 

  36. Newton PO, Marks M, Faro F, Betz R, Clements D, Haher T et al (2003) Use of video-assisted thoracoscopic surgery to reduce perioperative morbidity in scoliosis surgery. Spine 28:S249–S254. doi:10.1097/01.BRS.0000092475.04293.F5

    Article  PubMed  Google Scholar 

  37. Niemeyer T, Freeman BJ, Grevitt MP, Webb JK (2000) Anterior thoracoscopic surgery followed by posterior instrumentation and fusion in spinal deformities. Eur Spine J 9:499–504

    Article  PubMed  CAS  Google Scholar 

  38. O’Brein M, Kuklo T (2004) Spinal Deformity Study Group. Radiografic Measurement Manual. Ed. Medtronic Sofamor Danek

  39. Papin P, Arlet V, Marchesi D, Rosenblatt B, Aebi M (1999) Unusual presentation of spinal cord compression related to misplaced pedicle screws in thoracic scoliosis. Eur Spine J 8:156–160. doi:10.1007/s005860050147

    Article  PubMed  CAS  Google Scholar 

  40. Pellin B, Zielke K (1974) Severe scoliosis in adults and older, adolescents 41 operated cases. Rev Chir Orthop Reparatrice Appar Mot 60:623–633

    PubMed  CAS  Google Scholar 

  41. Polly DW, Potter BK, Kuklo T, Young S, Johnson C, Klemme WR (2004) Volumetric spinal canal intrusion: a comparison between thoracic pedicle screws and thoracic hooks. Spine 29:63–69. doi:10.1097/01.BRS.0000105525.06564.56

    Article  PubMed  Google Scholar 

  42. Rinella A, Lenke L, Whitaker C, Kim Y, Park SS, Peelle M et al (2005) Perioperative halo-gravity traction in the treatment of severe scoliosis and kyphosis. Spine 30:475–482. doi:10.1097/01.brs.0000153707.80497.a2

    Article  PubMed  Google Scholar 

  43. Savini R, Parisini P, Corbascio M, Prosperi L (1977). L’halo trazione associata alla fisio kinesi terapia nel trattamento correttivo delle scoliosi con gravissimi deficit respiratori. C·O.M vol XLIII° fasc. IV:353–360

  44. Savini R, Parisini P et al (1989) The surgical correction of severe vertebral deformities by combined anterior and posterior instrumentation. Prog Spinal Pathol 4:211–221

    Google Scholar 

  45. Shen J, Qiu G, Wang Y, Zhang Z, Zhao Y (2006) Comparison of 1-stage versus 2-stage anterior and posterior spinal fusion for severe and rigid idiopathic scoliosis—a randomized prospective study. Spine 31:2525–2528. doi:10.1097/01.brs.0000240704.42264.c4

    Article  PubMed  Google Scholar 

  46. Shufflebarger HL, Grimm JO, Bui V, Thomson JD (1991) Anterior and posterior spinal fusion. Staged versus same-day surgery. Spine 16:930–933. doi:10.1097/00007632-199108000-00011

    Article  PubMed  CAS  Google Scholar 

  47. Smythe WR, Carpenter JP (1997) Upper abdominal aortic iniury during spinal surgery. J Vasc Surg 25:774–777. doi:10.1016/S0741-5214(97)70310-0

    Article  PubMed  CAS  Google Scholar 

  48. Stokes IAF (1994) Three-dimensional terminology of spinal deformity. A report presented to the Scoliosis Research Society by the Scoliosis Research Society Working Group on 3-D terminology of spinal deformity. Spine 19:236–248

    Article  PubMed  CAS  Google Scholar 

  49. Suk SI, Lee CK, Min HJ, Cho KH, Oh JH (1994) Comparison of Cotrel-Dubousset pedicle screws and hooks in the treatment of idiopathic scoliosis. Int Orthop 18:341–346. doi:10.1007/BF00187077

    Article  PubMed  CAS  Google Scholar 

  50. Suk SI, Lee CK, Kim WJ, Chung YJ, Park YB (1995) Segmental pedicle screw fixation in the treatment of thoracic idiopathic scoliosis. Spine 20:1399–1405. doi:10.1097/00007632-199506000-00012

    Article  PubMed  CAS  Google Scholar 

  51. Suk SI, Kim WJ, Lee SM, Kim JH, Chung ER (2001) Thoracic pedicle screw fixation in spinal deformities. Are they really safe? Spine 26:2049–2057. doi:10.1097/00007632-200109150-00022

    Article  PubMed  CAS  Google Scholar 

  52. Suk SI, Lee SM, Chung ER, Kim JH, Kim WJ, Sohn HM (2003) Determination of distal fusion level with segmental pedicle screw fixation in single thoracic idiopathic scoliosis. Spine 28:484–491. doi:10.1097/00007632-200303010-00014

    Article  PubMed  Google Scholar 

  53. Suk SI, Chung ER, Kim JH, Kim SS, Lee JS, Choi WK (2005) Posterior vertebral column resection for severe rigid scoliosis. Spine 30:1682–1687. doi:10.1097/01.brs.0000170590.21071.c1

    Article  PubMed  Google Scholar 

  54. Tokunaga M, Minani S, Kitahara H, Isobe K, Nakata Y, Moriya H (2000) Vertebral decancellation for severe scoliosis. Spine 25:469–474. doi:10.1097/00007632-200002150-00013

    Article  PubMed  CAS  Google Scholar 

  55. Vaccaro AR, Rizzolo SJ, Allardyce TJ, Ramsey M, Salvo J, Balderston RA et al (1995) Placement of pedicle screws in the thoracic spine. Part I: morphometric analysis of the thoracic vertebrae. J Bone Joint Surg Am 77:1193–1199

    PubMed  CAS  Google Scholar 

  56. Vaccaro AR, Rizzolo SJ, Balderston RA, Allardyce TJ, Garfin SR, Dolinskas C et al (1995) Placement of pedicle screws in the thoracic spine: Part II: an anatomical and radiographic assessment. J Bone Joint Surg Am 77:1200–1206

    PubMed  CAS  Google Scholar 

  57. Vaughan JJ, Winter RB, Lonstein JE (1996) Comparison of the use of supine bending and traction radiographs in the selection of the fusion area in adolescent idiopathic scoliosis. Spine 21:2469–2473. doi:10.1097/00007632-199611010-00012

    Article  PubMed  CAS  Google Scholar 

  58. Wilber RG, Thompson GH, Shaffer JW, Brown RH, Nash CL Jr (1984) Postoperative neurological deficits in segmental spinal instrumentation. A study using spinal cord monitoring. J Bone Joint Surg Am 66:1178–1187

    PubMed  CAS  Google Scholar 

  59. Xu R, Ebraheim NA, Ou Y, Yeasting RA (1998) Anatomic consideration of pedicle screw placement in the thoracic spine. Roy-Camille technique versus Open-Lamina tecnique. Spine 23:1065–1068. doi:10.1097/00007632-199805010-00021

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Spine Surgery Department, Istituti Ortopedici Rizzoli, Via Pupilli 1, 40136, Bologna, Italy

    Mario Di Silvestre, Georgios Bakaloudis, Francesco Lolli, Francesco Vommaro, Konstantinos Martikos & Patrizio Parisini

Authors
  1. Mario Di Silvestre
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Georgios Bakaloudis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Francesco Lolli
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Francesco Vommaro
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Konstantinos Martikos
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Patrizio Parisini
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mario Di Silvestre.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Di Silvestre, M., Bakaloudis, G., Lolli, F. et al. Posterior fusion only for thoracic adolescent idiopathic scoliosis of more than 80°: pedicle screws versus hybrid instrumentation. Eur Spine J 17, 1336–1349 (2008). https://doi.org/10.1007/s00586-008-0731-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-008-0731-9

Keywords

Search

Navigation