European Spine Journal

, Volume 20, Issue 7, pp 1114–1117 | Cite as

Selective posterior thoracic fusion by means of direct vertebral derotation in adolescent idiopathic scoliosis: effects on the sagittal alignment

  • Kiril V. Mladenov
  • Christiane Vaeterlein
  • Ralf Stuecker
Original Article


The objectives of this retrospective study were to evaluate the effect of direct vertebral derotation on the sagittal alignment of the spine after selective posterior thoracic fusion for Lenke Type I adolescent idiopathic scoliosis (AIS). Preservation of the sagittal alignment has become critical in the management of spinal deformity. Better coronal and rotational corrections in posterior selective thoracic fusion for AIS have been reported with direct vertebral derotation as compared with the simple rod rotation technique. A greater lordogenic effect has been anticipated with direct vertebral derotation; however, data comparing those two techniques in terms of correction in the sagittal plane are still lacking. Standing full-spine PA and standard lateral serial X-rays of a total of 30 consecutive patients with adolescent idiopathic scoliosis treated between 2002 and 2008 at a single institution were evaluated. All the patients had Lenke Type I curves and underwent selective posterior thoracic fusion with pedicle screw instrumentation. Patients who were treated with additional osteotomies and concave or convex thoracoplasty or concomitant anterior releases were excluded. Minimum follow-up period was 24 months. Preoperative and postoperative coronal and sagittal spinal alignments in both the groups were compared. In 13 patients, the correction was achieved by means of a simple rod rotation (SRR). In 17 patients, the technique of direct vertebral derotation (DVD) was used. Scoliosis correction averaged 67 and 69%, respectively, and was similar in both groups (p > 0.05). Thoracic kyphosis and lumbar lordosis remained unchanged in the SRR group (p > 0.1). In the direct vertebral derotation group, a significant decrease of both thoracic kyphosis and lumbar lordosis of 8.1° and 11.8°, respectively, was observed (p < 0.0001). Global sagittal balance remained within normal limits in all the patients at the latest follow-up. Decrease in thoracic kyphosis and lumbar lordosis should be taken into account when using direct vertebral derotation for selective posterior thoracic fusion in AIS. In order to preserve sagittal alignment in these patients, ultra hard rods or maneuvers that pull posteriorly the concave side of the spine, thus avoiding the application of additional flattening forces should be considered.


Direct vertebral derotation Sagittal alignment AIS 


  1. 1.
    Majdouline Y, Aubin CE, Robitaille M et al (2007) Scoliosis correction objectives in adolescent idiopathic scoliosis. J Pediatr Orthop 27:775–781PubMedCrossRefGoogle Scholar
  2. 2.
    Newton PO, Yaszay B, Upasani VV, Pawelek JB, Bastrom TP, Lenke LG, Lowe T, Crawford A, Betz R, Lonner B, Group Harms Study (2010) Preservation of thoracic kyphosis is critical to maintain lumbar lordosis in the surgical treatment of adolescent idiopathic scoliosis. Spine 35(14):1365–1370PubMedGoogle Scholar
  3. 3.
    Cotrel Y, Dubousset J, Guillomat M (1988) New universal instrumentation in spinal surgery. Clin Orthop 227:10–23PubMedGoogle Scholar
  4. 4.
    Suk SI, Lee CK, Kim WJ et al (1995) Segmental pedicle screw fixation in the treatment of thoracic idiopathic scoliosis. Spine 20:1399–1405PubMedGoogle Scholar
  5. 5.
    Bridwell KH (1994) Surgical treatment of adolescent idiopathic scoliosis: the basics and the controversies. Spine 19:1095–1100PubMedCrossRefGoogle Scholar
  6. 6.
    Lee SM, Suk SI, Chung E-R (2004) Direct vertebral rotation: a new technique of three-dimensional deformity correction with segmental pedicle screw fixation in adolescent idiopathic scoliosis. Spine 29(3):343–349PubMedCrossRefGoogle Scholar
  7. 7.
    Hayashi K, Upasani VV, Pawelek JB, Aubin C-E, Labelle H, Lenke LG, Jackson R, Newton PO (2009) Three-dimensional analysis of thoracic apical sagittal alignment in adolescent idiopathic scoliosis. Spine 34(8):792–797PubMedCrossRefGoogle Scholar
  8. 8.
    La Grone MO (1988) Loss of lumbar lordosis. A complication of spinal fusion for scoliosis. Orthop Clin North Am 19:383–393PubMedGoogle Scholar
  9. 9.
    Lowenstein JE, Matsumoto H, Vitale MG et al (2007) Coronal and sagittal plane correction in adolescent idiopathic scoliosis: a comparison between all pedicle screw versus hybrid thoracic hook lumbar screw constructs. Spine 32:448–452PubMedCrossRefGoogle Scholar
  10. 10.
    Kim YJ, Lenke LG, Kim J et al (2006) Comparative analysis of pedicle screw versus hybrid instrumentation in posterior spinal fusion of adolescent idiopathic scoliosis. Spine 31:291–298PubMedCrossRefGoogle Scholar
  11. 11.
    Vora V, Crawford A, Babekhir N et al (2007) A pedicle screw construct gives an enhanced posterior correction of adolescent idiopathic scoliosis when compared with other constructs: myth or reality. Spine 32:1869–1874PubMedCrossRefGoogle Scholar
  12. 12.
    Kim YJ, Lenke LG, Cho SK et al (2004) Comparative analysis of pedicle screw versus hook instrumentation in posterior spinal fusion of adolescent idiopathic scoliosis. Spine 29:2040–2048PubMedCrossRefGoogle Scholar
  13. 13.
    Dickson RA, Lawton JO, Archer IA et al (1984) The pathogenesis of idiopathic scoliosis. Bi-planar spinal asymmetry. J Bone Joint Surg [Br] 66:8–15Google Scholar
  14. 14.
    Dickson RA (1992) The etiology and pathogenesis of idiopathic scoliosis. Acta Orthop Belg 58(suppl):21–25PubMedGoogle Scholar
  15. 15.
    Guo X, Chaw WW, Chan YL et al (2003) Relative anterior spinal overgrowth in adolescent idiopathic scoliosis. Results of disproportionate endochondral membranous bone growth. J Bone Joint Surg [Br] 85:1026–1031CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Kiril V. Mladenov
    • 1
  • Christiane Vaeterlein
    • 1
  • Ralf Stuecker
    • 1
  1. 1.Altona Children’s HospitalHamburgGermany

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