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Progressive Changes in Sagittal Contour After Anterior Spinal Fusion With Instrumentation of Different Sizes for Thoracic Adolescent Idiopathic Scoliosis: Is Continued Posterior Spinal Growth an Issue in Skeletally Immature Children?

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Abstract

Study Design

Retrospective analysis of radiographs for a prospective group of 196 adolescent patients with thoracic idiopathic scoliosis after anterior spinal fusion with instrumentation.

Objectives

To analyze progressive changes in the sagittal profile of immature and mature patients during the first 2 postoperative years.

Summary of Background Data

In a previous study of similar patients, a flexible 3.2-mm rod construct was used. An additional 15° (average) of kyphosis was seen in 60% of Risser 0 patients. The current patient group had fusion with solid rod (>4.0-mm) instrumentation.

Methods

All included patients had single anterior rod instrumentation, clinical and radiographic evidence of solid fusion, a minimum follow-up of 2 years, and a coronal progression of ⩽5° including adequate biplanar standard radiographs at preoperative, immediate postoperative, and 2-year follow-up visits. Patients were stratified by skeletal maturity and preoperative thoracic kyphosis. Significant sagittal progression was defined as > 10°.

Results

Significant sagittal progression that caused the patient to be hyperkyphotic (T5—T12 > 40°) occurred in 18.37% of the 196 study patients. A total of 55 who were group I Risser 0 at the time of surgery and 141 were group II Risser 1—5. Progression occurred much more frequently in Risser 0 patients who had a preoperative T5—T12 of ⩾ 30° (67.67%) versus Risser 1—5 patients (25.00%).

Conclusions

Compared with the authors’ previous work, solid rod instrumentation (>4.0 mm) for anterior spinal fusion for thoracic scoliosis is better at preventing progressive thoracic kyphosis than the flexible rod (3.2 mm). However, when performing a thoracic anterior spinal instrumented fusion in skeletally immature patients when the preoperative T5—T12 sagittal curve is >30° it is recommended to leave a low normal kyphosis (20°) in the instrumented region of T5—T12.

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References

  1. Ouellet JA, Johnston CE. Effect of grafting technique on the maintenance of coronal and sagittal correction in anterior treatment of scoliosis. Spine (Phila Pa 1976) 2002;27:2129–36.

    Article  Google Scholar 

  2. Betz RR, Harms J, Clements DH, et al. Comparison of anterior and posterior instrumentation for correction of adolescent thoracic idiopathic scoliosis. Spine (Phila Pa 1976) 1999;24:225–39.

    Article  CAS  Google Scholar 

  3. Sweet FA, Lenke LG, Blanke K, et al. Prospective radiographic and clinical outcomes and complications of single solid rod instrumented anterior spinal fusion in adolescent idiopathic scoliosis. Paper presented at the Scoliosis Research Society; September 18—21, 2000; Cairns, North Queensland, Australia.

    Google Scholar 

  4. Lenke LG, Betz RR, Harms J, et al. Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis. J Bone Joint Surg Am 2001;83:1169–81.

    Article  CAS  Google Scholar 

  5. Rhee JM, Bridwell KH, Won DS, et al. Sagittal plane analysis of adolescent idiopathic scoliosis: the effect of anterior versus posterior instrumentation. Spine (Phila Pa 1976) 2002;27:2350–6.

    Article  Google Scholar 

  6. Smith JA, Deviren V, Berven S, et al. Does instrumented anterior scoliosis surgery lead to kyphosis, pseudarthrosis, or inadequate correction in adults? Spine (Phila Pa 1976) 2002;27:529–34.

    Article  Google Scholar 

  7. D’Andrea LP, Betz RR, Lenke LG, et al. The effect of continued spinal growth on sagittal contour in patients treated by anterior instrumentation for adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2000;25:813–8.

    Article  Google Scholar 

  8. Dubousset J, Herring JA, Shufflegarger H. The crankshaft phenomenon. J Pediatr Orthop 1989;9:541–50.

    Article  CAS  Google Scholar 

  9. Spiegel DA, Cunningham BW, Oda I, et al. Anterior vertebral screw strain with and without solid interspace support. Spine (Phila Pa 1976) 2000;25:2755–61.

    Article  CAS  Google Scholar 

  10. Snyder BD, Zaltz I, Breitenbach MA, et al. Does bracing affect bone density in adolescent idiopathic scoliosis? Spine (Phila Pa 1976) 1995;20:1554–60.

    Article  CAS  Google Scholar 

  11. Lim TH, Evanich C, Hasanoglu KY, et al. Strength of anterior vertebral screw fixation in relationship to bone mineral density. J Spinal Disord 1995;8:121–5.

    Article  CAS  Google Scholar 

  12. Breeze SW, Doherty BJ, Noble PS, et al. A biomechanical study of anterior thoracolumbar screw fixation. Spine (Phila Pa 1976) 1998;23:1829–31.

    Article  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, SUNY Upstate Medical University, 6620 Fly Road, Suite 200, East Syracuse, NY, 13057, USA

    William F. Lavelle MD

  2. Brandywine Institute of Orthopaedics, 1561 Medical Dr, Pottstown, PA, USA

    Linda Park D’Andrea MD

  3. Department of Orthopedic Surgery, Cooper Bone and Joint Institute, Three Cooper Plaza Suite 403 Camden, New Jersey, 08103, USA

    David H. Clements III MD

  4. Department of Orthopedic Surgery, The Institute for Spine and Scoliosis, 3551 N Broad St, Philadelphia, PA, 19140, USA

    Randal R. Betz MD

Authors
  1. William F. Lavelle MD
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  2. Linda Park D’Andrea MD
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  3. David H. Clements III MD
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  4. Randal R. Betz MD
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Consortia

Members of the Harms Study Group

Corresponding author

Correspondence to William F. Lavelle MD.

Additional information

Author disclosures: WFL (grant from DePuy Spine); LPD (none); DHC (grants from DePuy Synthes Spine, during the conduct of the study; grants from DePuy synthes Spine, outside the submitted work; DePuy Synthes Spine Educational seminar participant.); RRB (personal fees from DePuy Synthes Spine; personal fees from SpineGuard, personal fees from Medtronic, personal fees from Orthocon; other from Orthobond, other from MiMedx; personal fees from Thieme, outside the submitted work).

This study was supported by a research grant from DePuy Spine to the Harms Study Group

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Lavelle, W.F., D’Andrea, L.P., Clements, D.H. et al. Progressive Changes in Sagittal Contour After Anterior Spinal Fusion With Instrumentation of Different Sizes for Thoracic Adolescent Idiopathic Scoliosis: Is Continued Posterior Spinal Growth an Issue in Skeletally Immature Children?. Spine Deform 2, 386–391 (2014). https://doi.org/10.1016/j.jspd.2014.03.010

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  • DOI: https://doi.org/10.1016/j.jspd.2014.03.010

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