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Efficacy and safety of posteromedial translation for correction of thoracic curves in adolescent idiopathic scoliosis using a new connection to the spine: the Universal Clamp

European Spine Journal volume 18, Article number: 158 (2009) Cite this article

Abstract

Correction of adolescent idiopathic scoliosis (AIS) has been reported with various systems. All-screw constructs are currently the most popular, but they have been associated with a significant decrease in thoracic kyphosis, with a potential risk of junctional kyphosis, not observed with hybrid constructs in the literature. In addition, it is important to weigh potential advantages of pedicle screw fixation against risks specific to its use. Because hybrid constructs are associated with a lower risk of complications and better sagittal correction than all-screw constructs, at present we use lumbar pedicle screws combined with a new sublaminar connection to the spine (Universal Clamps) at thoracic levels. The purpose of this study was to determine the efficacy and safety of the Universal Clamp (UC) posteromedial translation technique for correction of AIS. Seventy-five consecutive patients underwent posterior spinal fusion and hybrid instrumentation for progressive AIS. Correction was performed at the thoracic level using posteromedial translation. At the lumbar level, correction was performed using in situ contouring and compression/distractions maneuvers. A minimum 2-year follow-up was required. Medical data and radiographs were prospectively analyzed and compared using a paired t test. The average age at surgery was 15 years and 4 months (±19 months). The average number of levels fused was 12 ± 1.6. The mean follow-up was 30 ± 5 months. The average preoperative Cobb angle of the major curve was 60° ± 20°. The immediate postoperative major curve correction averaged 66 ± 13%. The average loss of correction of the major curve between the early postoperative assessment and latest follow-up was 3.5° ± 1.4°. The mean Cincinnati correction index was 1.7 ± 0.8 postoperatively, and 1.57 ± 1 at last follow up. The mean rotation of the apical vertebra was corrected from 23.3° ± 9° preoperatively to 7.3° ± 5° at last follow up (69% improvement, P < 0.0001). In the sagittal plane, the mean thoracic kyphosis improved from 23.8° ± 14.2° preoperatively to 32.3° ± 7.3° at last follow up. For the 68 patients who had a normokyphotic or a hypokyphotic sagittal modifier, thoracic kyphosis increased from 20.5° ± 9.9° to 31.8° ± 7.4°, corresponding to a mean kyphosis correction of 55% at last follow up. No intraoperative complication occurred and none of the patients developed proximal junctional kyphosis during the follow up. The principal limitation of the UC technique was the rate of proximal posterior prominence (14.6%), leading us to recommend the use of conventional claws at the upper extremity of the construct. The technique was safe, and reduced operative time, radiation exposure, and blood loss. While achieving correction of deformity in the coronal and axial planes equivalent to the best reported results of all-screw or previous hybrid constructs, the UC hybrid technique appears to provide superior correction in the sagittal plane. The excellent outcome in all three planes was maintained at 2 year follow up.

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References

  1. Asher MA (1997) Isola spinal instrumentation system for scoliosis. In: Bridwell KH, DeWald RL (eds) The textbook of spinal surgery. Lippincott-Raven, Philadelphia, pp 596–606

    Google Scholar 

  2. Barr SJ, Schuette AM, Emans JB (1997) Lumbar pedicle screws versus hooks. Results in double major curves in adolescent idiopathic scoliosis. Spine 22:1369–1379. doi:10.1097/00007632-199706150-00016

    PubMed  Article  CAS  Google Scholar 

  3. Bess RS, Lenke LG, Bridwell KH, Cheh G, Mandel S, Sides B (2007) Comparison of thoracic pedicle screw to hook instrumentation for the treatment of adult spinal deformity. Spine 32:555–561. doi:10.1097/01.brs.0000256445.31653.0e

    PubMed  Article  Google Scholar 

  4. Burton DC, Asher MA, Lai SM (1999) The selection of fusion levels using torsional correction techniques in the surgical treatment of idiopathic scoliosis. Spine 24:1728–1739. doi:10.1097/00007632-199908150-00015

    PubMed  Article  CAS  Google Scholar 

  5. Cheng I, Kim Y, Gupta MC, Bridwell KH, Hurford RK, Lee SS, Theerajunyaporn T, Lenke LG (2005) Apical sublaminar wires versus pedicle screws—which provides better results for surgical correction of adolescent idiopathic scoliosis? Spine 30:2104–2112. doi:10.1097/01.brs.0000179261.70845.b7

    PubMed  Article  Google Scholar 

  6. Cotrel Y, Dubousset J (1984) A new technique for segmental spinal osteosynthesis using the posterior approach. Rev Chir Orthop Repar Appar Mot 70:489–494

    Google Scholar 

  7. Dickson JH (1973) An eleven-year clinical investigation of Harrington instrumentation. A preliminary report on 578 cases. Clin Orthop Relat Res 113–130

  8. Dobbs MB, Lenke LG, Kim YJ, Kamath G, Peelle MW, Bridwell KH (2006) Selective posterior thoracic fusions for adolescent idiopathic scoliosis: comparison of hooks versus pedicle screws. Spine 31:2400–2404. doi:10.1097/01.brs.0000240212.31241.8e

    PubMed  Article  Google Scholar 

  9. Fitch RD, Turi M, Bowman BE, Hardaker WT (1990) Comparison of Cotrel–Dubousset and Harrington rod instrumentations in idiopathic scoliosis. J Pediatr Orthop 10:44–47

    PubMed  CAS  Google Scholar 

  10. Hamill CL, Lenke LG, Bridwell KH, Chapman MP, Blanke K, Baldus C (1996) The use of pedicle screw fixation to improve correction in the lumbar spine of patients with idiopathic scoliosis. Is it warranted? Spine 21:1241–1249. doi:10.1097/00007632-199605150-00020

    Google Scholar 

  11. Hullin MG, McMaster MJ, Draper ER, Duff ES (1991) The effect of Luque segmental sublaminar instrumentation on the rib hump in idiopathic scoliosis. Spine 16:402–408. doi:10.1097/00007632-199104000-00002

    PubMed  Article  CAS  Google Scholar 

  12. Kim YJ, Lenke LG, Bridwell KH, Kim J, Cho SK, Cheh G, Yoon J (2007) Proximal junctional kyphosis in adolescent idiopathic scoliosis after 3 different types of posterior segmental spinal instrumentation and fusions: incidence and risk factor analysis of 410 cases. Spine 32:2731–2738. doi:10.1097/BRS.0b013e318074c3ce

    PubMed  Article  Google Scholar 

  13. Kim YJ, Lenke LG, Cho SK, Bridwell KH, Sides B, Blanke K (2004) Comparative analysis of pedicle screw versus hook instrumentation in posterior spinal fusion of adolescent idiopathic scoliosis. Spine 29:2040–2048. doi:10.1097/01.brs.0000138268.12324.1a

    PubMed  Article  Google Scholar 

  14. Kim YJ, Lenke LG, Kim J, Bridwell KH, Cho SK, Cheh G, Sides B (2006) Comparative analysis of pedicle screw versus hybrid instrumentation in posterior spinal fusion of adolescent idiopathic scoliosis. Spine 31:291–298. doi:10.1097/01.brs.0000197865.20803.d4

    PubMed  Article  Google Scholar 

  15. Kock HJ, Sturmer KM, Letsch R, Schmit-Neuerburg KP (1994) Interface and biocompatibility of polyethylene terephthalate knee ligament prostheses. A histological and ultrastructural device retrieval analysis in failed synthetic implants used for surgical repair of anterior cruciate ligaments. Arch Orthop Trauma Surg 114:1–7. doi:10.1007/BF00454727

    PubMed  Article  CAS  Google Scholar 

  16. Konno S, Kikuchi S (2000) Prospective study of surgical treatment of degenerative spondylolisthesis: comparison between decompression alone and decompression with graf system stabilization. Spine 25:1533–1537. doi:10.1097/00007632-200006150-00012

    PubMed  Article  CAS  Google Scholar 

  17. Kuklo TR, Potter BK, Polly DW Jr, Lenke LG (2005) Monaxial versus multiaxial thoracic pedicle screws in the correction of adolescent idiopathic scoliosis. Spine 30:2113–2120. doi:10.1097/01.brs.0000179260.73267.f4

    PubMed  Article  Google Scholar 

  18. Lee SM, Suk SI, Chung ER (2004) Direct vertebral rotation: a new technique of three-dimensional deformity correction with segmental pedicle screw fixation in adolescent idiopathic scoliosis. Spine 29:343–349. doi:10.1097/01.BRS.0000109991.88149.19

    PubMed  Article  Google Scholar 

  19. Lenke LG, Betz RR, Harms J, Bridwell KH, Clements DH, Lowe TG, Blanke K (2001) Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis. J Bone Joint Surg Am 83-A:1169–1181

    PubMed  CAS  Google Scholar 

  20. Lowenstein JE, Matsumoto H, Vitale MG, Weidenbaum M, Gomez JA, Lee FY, Hyman JE, Roye DP Jr (2007) Coronal and sagittal plane correction in adolescent idiopathic scoliosis: a comparison between all pedicle screw versus hybrid thoracic hook lumbar screw constructs. Spine 32:448–452. doi:10.1097/01.brs.0000255030.78293.fd

    PubMed  Article  Google Scholar 

  21. Luque ER (1982) Segmental spinal instrumentation for correction of scoliosis. Clin Orthop Relat Res 192–198

  22. Mac-Thiong JM, Labelle H, Rooze M, Feipel V, Aubin CE (2003) Evaluation of a transpedicular drill guide for pedicle screw placement in the thoracic spine. Eur Spine J 12:542–547. doi:10.1007/s00586-003-0549-4

    PubMed  Article  Google Scholar 

  23. Nicastro JF, Hartjen CA, Traina J, Lancaster JM (1986) Intraspinal pathways taken by sublaminar wires during removal. An experimental study. J Bone Joint Surg Am 68:1206–1209

    PubMed  CAS  Google Scholar 

  24. Perdriolle R (1979) La scoliose. Son étude tridimensionnelle. Maloine, Paris

    Google Scholar 

  25. Perisinakis K, Theocharopoulos N, Damilakis J, Katonis P, Papadokostakis G, Hadjipavlou A, Gourtsoyiannis N (2004) Estimation of patient dose and associated radiogenic risks from fluoroscopically guided pedicle screw insertion. Spine 29:1555–1560. doi:10.1097/01.BRS.0000131214.57597.21

    PubMed  Article  Google Scholar 

  26. Rajnics P, Pomero V, Templier A, Lavaste F, Illes T (2001) Computer-assisted assessment of spinal sagittal plane radiographs. J Spinal Disord 14:135–142. doi:10.1097/00002517-200104000-00008

    PubMed  Article  CAS  Google Scholar 

  27. Remes V, Helenius I, Schlenzka D, Yrjonen T, Ylikoski M, Poussa M (2004) Cotrel–Dubousset (CD) or Universal Spine System (USS) instrumentation in adolescent idiopathic scoliosis (AIS): comparison of midterm clinical, functional, and radiologic outcomes. Spine 29:2024–2030. doi:10.1097/01.brs.0000138408.64907.dc

    PubMed  Article  Google Scholar 

  28. Sawyer PN, Stanczewski B, Hoskin GP, Sophie Z, Stillman RM, Turner RJ, Hoffman HL Jr (1979) In vitro and in vivo evaluations of dacron velour and knit prostheses. J Biomed Mater Res 13:937–956. doi:10.1002/jbm.820130611

    PubMed  Article  CAS  Google Scholar 

  29. Seitz H, Marlovits S, Schwendenwein I, Muller E, Vecsei V (1998) Biocompatibility of polyethylene terephthalate (Trevira hochfest) augmentation device in repair of the anterior cruciate ligament. Biomaterials 19:189–196. doi:10.1016/S0142-9612(97)00201-9

    PubMed  Article  CAS  Google Scholar 

  30. Senaran H, Shah SA, Gabos PG, Littleton AG, Neiss G, Guille JT (2008) Difficult thoracic pedicle screw placement in adolescent idiopathic scoliosis. J Spinal Disord Tech 21:187–191. doi:10.1097/BSD.0b013e318073cc1d

    PubMed  Article  Google Scholar 

  31. Senegas J, Vital JM, Pointillart V, Mangione P (2007) Long-term actuarial survivorship analysis of an interspinous stabilization system. Eur Spine J 16:1279–1287. doi:10.1007/s00586-007-0359-1

    PubMed  Article  Google Scholar 

  32. 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

    PubMed  Article  CAS  Google Scholar 

  33. Suk SI, Lee SM, Chung ER, Kim JH, Kim SS (2005) Selective thoracic fusion with segmental pedicle screw fixation in the treatment of thoracic idiopathic scoliosis: more than 5-year follow-up. Spine 30:1602–1609. doi:10.1097/01.brs.0000169452.50705.61

    PubMed  Article  Google Scholar 

  34. Takahata M, Ito M, Abumi K, Kotani Y, Sudo H, Ohshima S, Minami A (2007) Comparison of novel ultra-high molecular weight polyethylene tape versus conventional metal wire for sublaminar segmental fixation in the treatment of adolescent idiopathic scoliosis. J Spinal Disord Tech 20:449–455. doi:10.1097/BSD.0b013e318030d30e

    PubMed  Article  Google Scholar 

  35. Upendra BN, Meena D, Chowdhury B, Ahmad A, Jayaswal A (2008) Outcome-based classification for assessment of thoracic pedicular screw placement. Spine 33:384–390

    PubMed  Article  Google Scholar 

  36. Vialle R, Levassor N, Rillardon L, Templier A, Skalli W, Guigui P (2005) Radiographic analysis of the sagittal alignment and balance of the spine in asymptomatic subjects. J Bone Joint Surg Am 87:260–267. doi:10.2106/JBJS.D.02043

    PubMed  Article  Google Scholar 

  37. Vora V, Crawford A, Babekhir N, Boachie-Adjei O, Lenke L, Peskin M, Charles G, Kim Y (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. doi:10.1097/BRS.0b013e318108b912

    PubMed  Article  Google Scholar 

  38. Weiss HR (1995) Measurement of vertebral rotation: perdriolle versus raimondi. Eur Spine J 4:34–38. doi:10.1007/BF00298416

    PubMed  Article  CAS  Google Scholar 

  39. Willers U, Hedlund R, Aaro S, Normelli H, Westman L (1993) Long-term results of Harrington instrumentation in idiopathic scoliosis. Spine 18:713–717. doi:10.1097/00007632-199305000-00007

    PubMed  Article  CAS  Google Scholar 

  40. Winter RB, Lonstein JE, Denis F (2007) How much correction is enough? Spine 32:2641–2643

    PubMed  Google Scholar 

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Acknowledgment

The authors want to acknowledge Jim Sneed, MD for his help in the edition of this manuscript.

Conflict of interest statement

One or more of the authors received financial support from Abbott Spine (Bordeaux, France) for this study.

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  1. Department of Pediatric Orthopaedics, Robert Debré Hospital, AP-HP, Paris 7 University, Paris, France

    Keyvan Mazda, Brice Ilharreborde, Julien Even, Yan Lefevre, Franck Fitoussi & Georges-François Penneçot

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  1. Keyvan Mazda
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  2. Brice Ilharreborde
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  4. Yan Lefevre
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Correspondence to Brice Ilharreborde.

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Mazda, K., Ilharreborde, B., Even, J. et al. Efficacy and safety of posteromedial translation for correction of thoracic curves in adolescent idiopathic scoliosis using a new connection to the spine: the Universal Clamp. Eur Spine J 18, 158 (2009). https://doi.org/10.1007/s00586-008-0839-y

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  • DOI: https://doi.org/10.1007/s00586-008-0839-y

Keywords

  • Adolescent idiopathic scoliosis
  • Sagittal balance
  • Correction
  • Instrumentation