Skip to main content

Advertisement

SpringerLink
Log in

The use of three rods in correcting severe scoliosis

  • Case Series
  • Published:
Spine Deformity Aims and scope Submit manuscript

Abstract

Purpose

The three-rod technique, utilising a short apical concavity rod is an option to achieve controlled correction in severe scoliosis. We describe this technique, the complications encountered, and the long-term outcomes.

Method

All paediatric patients who had at least 2 years follow-up after undergoing corrective surgery for scoliosis ≥ 100° using 3 parallel rods were included. Radiographs were assessed to evaluate the correction and clinical records examined for any loss of correction, complications, revision procedures or neuromonitoring events.

Results

Twenty-five patients met the inclusion criteria. Four underwent prior anterior fusion to prevent crankshaft phenomenon. The mean angle of the deformity was 112.0° (range 100.3–137.1). Mean maximal kyphosis was 48.8° (range 11.4–78.8°) and mean curve flexibility 4.4% (range 0–37.0%). Intraoperative traction achieved an average of 70.4% (95% CI 56.6–84.1%). Nine patients (39%) showed a reduction in MEPs during definitive surgery. All returned to within 75% of baseline by the end of surgery. All patients had normal postoperative neurology. One patient underwent removal of hardware for late infection. The mean overall Cobb correction was 55.7° (95% CI 50.2–61.2°), equating to 50.2% (95% CI 44.9–55.4%) of the mean initial deformity. Thoracic kyphosis reduced by a mean of 18.2° (95% CI 12.8–23.6°).

Conclusion

Our series suggests that three-rod constructs are able to safely and effectively achieve 50% correction of severe scoliosis.

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.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Harrington P (1962) Treatment of scoliosis. Correction and internal fixation by spine instrumentation. J Bone Joint Surg Am 44-A:591–610

    Article  CAS  PubMed  Google Scholar 

  2. Koerner JD, Patel A, Zhao C, Schoenberg C, Mishra A, Vives MJ et al (2014) Blood loss during posterior spinal fusion for adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 39(18):1479–1487

    Article  Google Scholar 

  3. Yamin S, Li L, Xing W, Tianjun G, Yupeng Z (2008) Staged surgical treatment for severe and rigid scoliosis. J Orthop Surg Res 3:26

    Article  PubMed  PubMed Central  Google Scholar 

  4. Yu X, Xiao H, Wang R, Huang Y (2013) Prediction of massive blood loss in scoliosis surgery from preoperative variables. Spine 38(4):350–355

    Article  PubMed  Google Scholar 

  5. Mihara Y, Chung WH, Chiu CK, Hasan MS, Lee SY, Ch’ng PY et al (2019) Perioperative outcome of severe idiopathic scoliosis (cobb angle >/= 90 degrees): is there any difference between ‘daytime’ versus ‘after-hours’ surgeries? Spine. 45(6) 381–389

    Article  Google Scholar 

  6. Yang C, Wang H, Zheng Z, Zhang Z, Wang J, Liu H et al (2017) Halo-gravity traction in the treatment of severe spinal deformity: a systematic review and meta-analysis. Eur Spine J: Off Publ Eur Spine Soc, Eur Spinal Deform Soc, Eurn Sect Cerv Spine Res Soc 26(7):1810–1816

    Article  Google Scholar 

  7. Patel A, Ruparel S, Dusad T, Mehta G, Kundnani V (2018) Posterior-approach single-level apical spinal osteotomy in pediatric patients for severe rigid kyphoscoliosis: long-term clinical and radiological outcomes. J Neurosurg Pediatr 21(6):606–614

    Article  PubMed  Google Scholar 

  8. Xia L, Li N, Wang D, Liu M, Li JW, Bao DM et al (2017) One-stage posterior spinal osteotomy in severe spinal deformities: a total of 147 cases. Clin Spine Surg 30(4):E448–E453

    Article  PubMed  Google Scholar 

  9. Sacramento-Dominguez C, Yagi M, Ayamga J, Nemani VM, Akoto H, Mahmud R et al (2015) Apex of deformity for three-column osteotomy. Does it matter in the occurrence of complications? Spine J 15(11):2351–2359

    Article  PubMed  Google Scholar 

  10. Wang XB, Lenke LG, Thuet E, Blanke K, Koester LA, Roth M (2016) Deformity angular ratio describes the severity of spinal deformity and predicts the risk of neurologic deficit in posterior vertebral column resection surgery. Spine 41(18):1447–1455

    Article  PubMed  Google Scholar 

  11. Lewis ND, Keshen SG, Lenke LG, Zywiel MG, Skaggs DL, Dear TE et al (2015) The deformity angular ratio: does it correlate with high-risk cases for potential spinal cord monitoring alerts in pediatric 3-column thoracic spinal deformity corrective surgery? Spine 40(15):E879–E885

    Article  PubMed  Google Scholar 

  12. Bridwell KH, Kuklo TR, Lewis SJ, Sweet FA, Lenke LG, Baldus C (2001) String test measurement to assess the effect of spinal deformity correction on spinal canal length. Spine 26(18):2013–2019

    Article  CAS  PubMed  Google Scholar 

  13. Han CF, Hai Y, Yin P, Cha T, Li GA (2019) In-vivo change of the spine canal after surgical corrections of severe and rigid kyphoscoliosis. Zhonghua Yi Xue Za Zhi 99(41):3243–3248

    CAS  PubMed  Google Scholar 

  14. Boachie-Adjei O, Yagi M, Sacramento-Dominguez C, Akoto H, Cunningham ME, Gupta M et al (2014) Surgical risk stratification based on preoperative risk factors in severe pediatric spinal deformity surgery. Spine deformity 2(5):340–349

    Article  PubMed  Google Scholar 

  15. Lenke LG, Newton PO, Sucato DJ, Shufflebarger HL, Emans JB, Sponseller PD et al (2013) Complications after 147 consecutive vertebral column resections for severe pediatric spinal deformity: a multicenter analysis. Spine 38(2):119–132

    Article  PubMed  Google Scholar 

  16. Rothman RH, Simeone FA, Herkowitz HN (2018) Rothman-Simeone and Herkowitz’s, the spine, 7th edn. Elsevier, Philadelphia PA

    Google Scholar 

  17. Vialle R, Mary P, Harding I, Tassin JL, Guillaumat M (2008) Surgical treatment of severe thoracic scoliosis in skeletally mature patients. Orthopedics 31(3):218

    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: Off Publ Eur Spine Soc, Eur Spinal Deform Soc, Eurn Sect Cerv Spine Res Soc 8(1):8–15

    Article  Google Scholar 

  19. Cotrel Y (1986) Nouvelle instrumentation pour chirurgie du rachis. Freund Pub. House, London

    Google Scholar 

  20. Moe JH, Lonstein JE (1995) Moe’s textbook of scoliosis and other spinal deformities. Saunders, London

    Google Scholar 

  21. Tassin J, Guillaumat M (1995) Scolioses de l’Adulte. In: Pous J-G, Karger C (eds) Instrumentation rachidienne. Expansion Scientifique Française, Paris, pp 282–298

    Google Scholar 

  22. Di Silvestre M, Bakaloudis G, Lolli F, Vommaro F, Martikos K, Parisini P (2008) Posterior fusion only for thoracic adolescent idiopathic scoliosis of more than 80 degrees: pedicle screws versus hybrid instrumentation. Eur Spine J: Off Publ Eur Spine Soc, Eur Spinal Deform Soc, Eurn Sect Cerv Spine Res Soc 17(10):1336–1349

    Article  Google Scholar 

  23. Yang C, Zheng Z, Liu H, Wang J, Kim YJ, Cho S (2016) Posterior vertebral column resection in spinal deformity: a systematic review. Eur Spine J: Off Publ Eur Spine Soc, Eur Spinal Deform Soc, Eurn Sect Cerv Spine Res Soc 25(8):2368–2375

    Article  Google Scholar 

  24. Xie J, Wang Y, Zhao Z, Zhang Y, Si Y, Li T et al (2012) Posterior vertebral column resection for correction of rigid spinal deformity curves greater than 100 degrees. J Neurosurg Spine 17(6):540–551

    Article  PubMed  Google Scholar 

  25. Riley MS, Lenke LG, Chapman TM, Sides BA, Blanke KM, Kelly MP (2018) Clinical and radiographic outcomes after posterior vertebral column resection for severe spinal deformity with five-year follow-up. J Bone Joint Surg Am 100(5):396–405

    Article  PubMed  Google Scholar 

  26. Perry J (1972) The halo in spinal abnormalities: practical factors and avoidance of complications. Orthopc Clin North Am 3(1):69–80

    Article  CAS  Google Scholar 

  27. Sponseller PD, Takenaga RK, Newton P, Boachie O, Flynn J, Letko L et al (2008) The use of traction in the treatment of severe spinal deformity. Spine (Phila Pa 1976) 33(21):2305–2309

    Article  Google Scholar 

  28. Rinella A, Lenke LG, 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(4):475–482

    Article  PubMed  Google Scholar 

  29. Luhmann SJ, Lenke LG, Kim YJ, Bridwell KH, Schootman M (2005) Thoracic adolescent idiopathic scoliosis curves between 70 degrees and 100 degrees: is anterior release necessary? Spine 30(18):2061–2067

    Article  PubMed  Google Scholar 

  30. 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 degrees. Spine 31(20):2386–2391

    Article  PubMed  Google Scholar 

  31. Newton PO, Perry A, Bastrom TP, Lenke LG, Betz RR, Clements D et al (2007) Predictors of change in postoperative pulmonary function in adolescent idiopathic scoliosis: a prospective study of 254 patients. Spine 32(17):1875–1882

    Article  PubMed  Google Scholar 

  32. 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(7):1534–1541

    PubMed  Google Scholar 

  33. Lonner BS, Auerbach JD, Estreicher MB, Betz RR, Crawford AH, Lenke LG et al (2009) Pulmonary function changes after various anterior approaches in the treatment of adolescent idiopathic scoliosis. J Spinal Disord Tech 22(8):551–558

    Article  PubMed  Google Scholar 

  34. Vitale MG, Skaggs DL, Pace GI, Wright ML, Matsumoto H, Anderson RC et al (2014) Best practices in intraoperative neuromonitoring in spine deformity surgery: development of an intraoperative checklist to optimize response. Spine Deformity 2(5):333–339

    Article  PubMed  Google Scholar 

  35. Halsey MF, Myung KS, Ghag A, Vitale MG, Newton PO, de Kleuver M (2020) Neurophysiological monitoring of spinal cord function during spinal deformity surgery: 2020 SRS neuromonitoring information statement. Spine Deformity 8(4):591–596

    Article  PubMed  Google Scholar 

  36. Lewis SJ, Wong IHY, Strantzas S, Holmes LM, Vreugdenhil I, Bensky H et al (2019) Responding to intraoperative neuromonitoring changes during pediatric coronal spinal deformity surgery. Global Spine J 9(1 Suppl):15s–21s

    Article  PubMed  PubMed Central  Google Scholar 

  37. O’Brien MF (2004) Radiographic measurement manual. Medtronic Sofamor Danek USA, Memphis

    Google Scholar 

  38. Karikari IO, Pang H, Yankey KP, Duah HO, Akoto H, Hodes R et al (2019) A novel radiographic classification of severe spinal curvatures exceeding 100 degrees : the omega, gamma and alpha deformities. Eur Spine J: Off Publ Eur Spine Soc, Eur Spinal Deform Soc, Eurn Sect Cerv Spine Res Soc 28(6):1265–1276

    Article  Google Scholar 

Download references

Funding

No funding was received for this work.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1XB, Canada

    Brett Rocos, Eliane Rioux-Trottier, Masayoshi Machida, David E. Lebel & Reinhard Zeller

  2. Department of Orthopaedic Surgery, Dana Children’s Hospital, 6 Weizmann Street, 64239, Tel Aviv, Israel

    Amit Sigal

  3. Department of Orthopaedic Surgery, Children’s Health Ireland At Crumlin, Cooley Rd, Dublin, D12 N512, Ireland

    Jim Kennedy

  4. Associate Professor, University of Toronto, Room S107, 555 University Avenue, Toronto, ON, M5G 1XB, Canada

    David E. Lebel & Reinhard Zeller

Authors
  1. Brett Rocos
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eliane Rioux-Trottier
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Masayoshi Machida
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Amit Sigal
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jim Kennedy
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. David E. Lebel
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Reinhard Zeller
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

BR, MM, ER-T, AS. JK: Data collection, analysis and manuscript preparation. Approved final manuscript. DEL: Study conception, manuscript preparation, approved the final manuscript, corresponding author. RZ: Study conception, manuscript preparation. Approved final manuscript.

Corresponding author

Correspondence to David E. Lebel.

Ethics declarations

Conflicts of interest

None of the authors declare any competing interests of relevance to this work.

Ethics approval

Institutional ethics approval was granted for this study no 1000053025.

Availability of data and material

Data is made available through direct communication with the corresponding author.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rocos, B., Rioux-Trottier, E., Machida, M. et al. The use of three rods in correcting severe scoliosis. Spine Deform 9, 969–976 (2021). https://doi.org/10.1007/s43390-021-00300-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s43390-021-00300-y

Keywords

Search

Navigation