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Do the benefits of hook-hybrid construct justify their use over all-pedicle screws constructs in maintaining postoperative curve correction for adolescent idiopathic scoliosis patients from an Asian population?

Abstract

Study design

Retrospective study.

Objective

(1) Compare outcomes of all-pedicle screws (PS) and hook-hybrid (H) constructs in adolescent idiopathic scoliosis (AIS) patients; and (2) investigate whether BMI, height or pedicle size may modify the effect of the type of surgical construct on the extent of curve decompensation.

Methods

AIS patients who underwent surgical fixation with H or PS constructs at a single tertiary institution were reviewed. Patients with implant density of at least 70% and 2-year follow-up were included. Demographic and perioperative data collected were age, sex, height, BMI, implant density and pedicle diameter. Cobb’s angles and curve correction were compared preoperatively, postoperatively and at follow-up.

Results

In total, 59 patients were included. H group had a lower pedicle size at the highest level of construct and at T4 compared to PS group. Postoperatively, H group (30.2° ± 11.7°) and PS group (32.1° ± 10.4°) had similar correction (mean diff. 2.0°, p = 0.516). At 2-year follow-up, H group (1.6° ± 3.5°) and PS group (0.1° ± 2.8°) had similar curve deterioration (mean diff. 1.5°, p = 0.079). Uni- and multivariate analyses revealed that BMI and height were not associated with curve deterioration at 2-year follow-up among the H and PS groups.

Conclusion

H constructs provided similar maintenance of curve correction at 2-year follow-up compared to PS constructs. BMI and Stature did not modify curve deterioration between both groups at follow-up. This study supports the use of H constructs when faced with difficult pedicle morphology associated with shorter stature as it provides comparable and satisfactory long-term maintenance of curve correction.

Level of evidence

Level III, retrospective cohort study.

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This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Contributions

SWHT, GSG, LJ, RCCS: made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new softward used in the work. SWHT, GSG, LJ, RCCS: drafted the work or revised it critically for important intellectual content. SWHT, GSG, LJ, RCCS: Approved the version to be published. SWHT, GSG, LJ, RCCS: agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Samuel Wei Han Tan.

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The authors declare that there is no conflict of interest.

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Centralised institutional review board (IRB) approval (CIRB 2018/2356) was obtained for this study. Waiver of informed consent was approved for this retrospective study.

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Tan, S.W.H., Goh, G.S., Jiang, L. et al. Do the benefits of hook-hybrid construct justify their use over all-pedicle screws constructs in maintaining postoperative curve correction for adolescent idiopathic scoliosis patients from an Asian population?. Spine Deform 10, 865–871 (2022). https://doi.org/10.1007/s43390-022-00493-w

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Keywords

  • Adolescent idiopathic scoliosis
  • Posterior spinal fusion
  • Body mass index
  • Stature
  • Hooks
  • Pedicle screws
  • Small pedicle size