European Spine Journal

, Volume 27, Supplement 2, pp 165–174 | Cite as

Triplanar correction of adolescent idiopathic scoliosis by asymmetrically shaped and simultaneously applied rods associated with direct vertebral rotation: clinical and radiological analysis of 36 patients

  • Cesare FaldiniEmail author
  • Fabrizio Perna
  • Giuseppe Geraci
  • Francesco Pardo
  • Antonio Mazzotti
  • Federico Pilla
  • Alberto Ruffilli
Original Article



Aim of this study was to investigate the effectiveness of a new surgical corrective manoeuvre for adolescent idiopathic scoliosis (AIS) by asymmetrically shaped and simultaneously applied rods and in combination with direct vertebral rotation, to control both the triplanar deformity and the kyphosis apex location.


We retrospectively reviewed 36 patients who undergo surgical treatment using simultaneous translation on two differently contoured rods, in combination with direct vertebral rotation. Patients were divided into three main groups according to the scoliotic curve type.


The average follow-up was 1.8 years (range 1–3 years). Mean thoracic Cobb angle decreased from 64.6° to 17.0 (p < 0.05). Mean lumbar Cobb angle decreased from 54.9 to 13°. T5–T12 kyphosis values improved from 16.2 to 22.8° (p < 0.05). Apical vertebral rotation decreased from 25.3 to 9.7°. Mean total SRS-22 score values improved from 2.3 on pre-operative to 3.8 at the last available follow-up. Two major and two minor perioperative complications were recorded. Nor deformity progression or screw pull-out or non-union was recorded at the last available follow-up.


The corrective manoeuvre using two differently contoured rods simultaneously in combination with direct vertebral rotation can provide a good triplanar deformity correction and improve patient’s quality of life and self-image perception in mild-to-moderate AIS. Moreover, the described technique allows the positioning of the desired kyphosis apex at a different level from the scoliosis apex. This procedure allows a better sagittal contour restoration while maintaining a comparable amount of correction on the frontal and axial plane of the already available techniques.

Graphical Abstract

These slides can be retrieved under Electronic Supplementary Material.


Spine deformity Surgical technique Rib hump Vertebral rotation Sagittal balance Kyphosis 



No funding was received in support of this work.

Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest.

Supplementary material

586_2018_5595_MOESM1_ESM.pptx (7.6 mb)
Supplementary material 1 (PPTX 7799 kb)


  1. 1.
    Cobb JR (1947) Outline for the study of scoliosis. Instr Course Lect 5:261–275Google Scholar
  2. 2.
    Geissele AE, Ogilvie JW, Cohen M, Bradford DS (1994) Thoracoplasty for the treatment of rib prominence in thoracic scoliosis. Spine 19:1636–1642CrossRefGoogle Scholar
  3. 3.
    Faldini C, Chehrassan M, Borghi R et al (2017) Simultaneous dual-rod correction and direct vertebral rotation technique to correct double major adolescent idiopathic scoliosis curve. JAAOS 25:829. CrossRefGoogle Scholar
  4. 4.
    Hibbs RA (2007) An operation for progressive spinal deformities: a preliminary report of three cases from the service of the orthopaedic hospital. 1911. Clin Orthop 460:17–20. CrossRefPubMedGoogle Scholar
  5. 5.
    Harrington PR (2002) Treatment of scoliosis: correction and internal fixation by spine instrumentation. June 1962. J Bone Joint Surg Am 84–A:316CrossRefGoogle Scholar
  6. 6.
    Cotrel Y, Dubousset J (1984) A new technic for segmental spinal osteosynthesis using the posterior approach. Rev Chir Orthop Reparatrice Appar Mot 70:489–494PubMedGoogle Scholar
  7. 7.
    Lee S-M, Suk S-I, 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 29:343–349CrossRefGoogle Scholar
  8. 8.
    Suk SI, Lee CK, Kim WJ et al (1995) Segmental pedicle screw fixation in the treatment of thoracic idiopathic scoliosis. Spine 20:1399–1405CrossRefGoogle Scholar
  9. 9.
    Di Silvestre M, Lolli F, Bakaloudis G et al (2013) Apical vertebral derotation in the posterior treatment of adolescent idiopathic scoliosis: myth or reality? Eur Spine J 22:313–323. CrossRefPubMedGoogle Scholar
  10. 10.
    Melero P, Schwember R, Lopez S (2015) Direct vertebral rotation versus derotation technique in Lenke type 1 idiopathic scoliosis. Glob Spine J 5:s-0035–s1554466. CrossRefGoogle Scholar
  11. 11.
    Watanabe K, Nakamura T, Iwanami A et al (2012) Vertebral derotation in adolescent idiopathic scoliosis causes hypokyphosis of the thoracic spine. BMC Musculoskelet Disord 13:99. CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Emami A, Deviren V, Berven S et al (2002) Outcome and complications of long fusions to the sacrum in adult spine deformity: luque-galveston, combined iliac and sacral screws, and sacral fixation. Spine 27:776–786CrossRefGoogle Scholar
  13. 13.
    Aaro S, Dahlborn M (1981) Estimation of vertebral rotation and the spinal and rib cage deformity in scoliosis by computer tomography. Spine 6:460–467CrossRefGoogle Scholar
  14. 14.
    Koerner JD, Patel A, Zhao C et al (2014) Blood loss during posterior spinal fusion for adolescent idiopathic scoliosis. Spine 39:1479–1487. CrossRefPubMedGoogle Scholar
  15. 15.
    Perna F, Borghi R, Pilla F et al (2016) Pedicle screw insertion techniques: an update and review of the literature. Musculoskelet Surg. CrossRefPubMedGoogle Scholar
  16. 16.
    Lenke LG, Betz RR, Harms J et al (2001) Adolescent idiopathic scoliosis. J Bone Jt Surg 83(8):1169–1181CrossRefGoogle Scholar
  17. 17.
    Chang MS, Lenke LG (2009) Vertebral derotation in adolescent idiopathic scoliosis. Oper Tech Orthop 19:19–23. CrossRefGoogle Scholar
  18. 18.
    Kim YJ, Lenke LG, Bridwell KH et al (2004) Free hand pedicle screw placement in the thoracic spine: is it safe? Spine 29:333–342 (discussion 342)CrossRefGoogle Scholar
  19. 19.
    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 32:1869–1874. CrossRefPubMedGoogle Scholar
  20. 20.
    Suk SI, Kim WJ, Lee SM et al (2001) Thoracic pedicle screw fixation in spinal deformities: are they really safe? Spine 26:2049–2057CrossRefGoogle Scholar
  21. 21.
    Jaquith BP, Chase A, Flinn P et al (2012) Screws versus hooks: implant cost and deformity correction in adolescent idiopathic scoliosis. J Child Orthop 6:137–143. CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Vallespir GP, Flores JB, Trigueros IS et al (2008) Vertebral coplanar alignment: a standardized technique for three dimensional correction in scoliosis surgery: technical description and preliminary results in Lenke type 1 curves. Spine 33:1588–1597. CrossRefPubMedGoogle Scholar
  23. 23.
    Asghar J, Samdani AF, Pahys JM et al (2009) Computed tomography evaluation of rotation correction in adolescent idiopathic scoliosis: a comparison of an all pedicle screw construct versus a hook-rod system. Spine 34:804–807. CrossRefPubMedGoogle Scholar
  24. 24.
    Kadoury S, Cheriet F, Beauséjour M et al (2009) A three-dimensional retrospective analysis of the evolution of spinal instrumentation for the correction of adolescent idiopathic scoliosis. Eur Spine J 18:23–37. CrossRefPubMedGoogle Scholar
  25. 25.
    Kuklo TR, Potter BK, Polly DW, Lenke LG (2005) Monaxial versus multiaxial thoracic pedicle screws in the correction of adolescent idiopathic scoliosis. Spine 30:2113–2120CrossRefGoogle Scholar
  26. 26.
    Mladenov KV, Vaeterlein C, Stuecker R (2011) Selective posterior thoracic fusion by means of direct vertebral derotation in adolescent idiopathic scoliosis: effects on the sagittal alignment. Eur Spine J 20:1114–1117. CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Clement J-L, Chau E, Kimkpe C, Vallade M-J (2008) Restoration of thoracic kyphosis by posterior instrumentation in adolescent idiopathic scoliosis: comparative radiographic analysis of two methods of reduction. Spine 33:1579–1587. CrossRefPubMedGoogle Scholar
  28. 28.
    Lam GC, Hill DL, Le LH et al (2008) Vertebral rotation measurement: a summary and comparison of common radiographic and CT methods. Scoliosis 3:16. CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Faldini C, Perna F, Chehrassan M et al (2016) Simultaneous double rod and en-bloc direct vertebral rotation technique for correction of main thoracic adolescent idiopathic scoliosis: retrospective analysis of 14 cases. J Biol Regul Homeost Agents 30:181–186PubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Rizzoli Orthopaedic InstituteUniversity of BolognaBolognaItaly

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