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Anterior Dual Rod Versus Posterior Pedicle Fixation Surgery for the Surgical Treatment in Lenke 5C Adolescent Idiopathic Scoliosis: A Multicenter, Matched Case Analysis of 42 Patients

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Abstract

Study Design

Multicenter matched case analysis.

Objective

Compare patients with Lenke 5C scoliosis surgically treated with anterior spinal fusion with dual rod instrumentation and anterior column support versus posterior release and pedicle screw instrumentation.

Summary of Background Data

Treatment of single, structural, lumbar and thoracolumbar curves in patients with adolescent idiopathic scoliosis (AIS) has been the subject of some debate. Previous papers directly comparing these approaches are problematic because of heterogeneity of the groups, nonrandomized protocols, and surgeon bias and variation of instrumentation (upper instrumented vertebrae and lower instrumented vertebrae) in relation to the defined Cobb angle (upper end vertebra and lower end vertebrae). This report sought to remedy these flaws by analyzing a database of Lenke 5C AIS and performing matched cases.

Methods

We analyzed 96 patients with Lenke 5C AIS curves based on radiographic and clinical data at 3 institutions, surgically treated between 2001 and 2005 with minimum 2-year follow-up. Case matched criteria (age within 1 year, sex, curve within 5°, lower end vertebrae, and lower instrumented vertebrae) yielded 21 matched patient pairs. We evaluated and compared multiple clinical and radiographic parameters.

Results

We observed no significant statistical differences between groups in any preoperative clinical or radiographic parameters. At final follow-up, the major curve measured 8° (83%) in the posterior spinal fusion group, compared with 13° (72%) in the anterior spinal fusion group (p =.002). Estimated blood loss was similar in both groups. Hospital stay was significantly shorter in the posterior spinal fusion group. There were no differences in radiographic complications, such as proximal junctional kyphosis.

Conclusions

At a minimum of 2 years’ follow-up in a multicenter, matched case analysis, adolescents with Lenke 5C curves demonstrated statistically significantly better curve correction and shorter hospital stays when treated with a posterior release with pedicle screw instrumented fusion compared with an anterior instrumented fusion with dual rods for similar patient populations.

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Authors and Affiliations

  1. Seton Spine and Scoliosis Center, 1600 West 38th Street, Suite 200, Austin, TX, 78731, USA

    Matthew J. Geek MD & Dana Hawthorne PA

  2. Illinois Spine and Scoliosis Center, 12701 W 143rd St, #110, Homer Glen, IL, 60491, USA

    Anthony Rinella MD

  3. Miami Children’s Hospital, 3601 NW 107th Ave, Miami, FL, 33178, USA

    Angel Macagno MD & Harry L. Shufflebarger MD

  4. Washington University School of Medicine, 1 Children’s Pl, St Louis, MO, 63110, USA

    Linda Koester BS, Brenda Sides MA, Lawrence Lenke MD & Keith Bridwell MD

  5. Consulting Orthopedists, 4708 Alliance Boulevard, Suite 810, Piano, TX, 75093, USA

    Mike O’Brien MD

Authors
  1. Matthew J. Geek MD
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  2. Anthony Rinella MD
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  3. Dana Hawthorne PA
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  4. Angel Macagno MD
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  5. Linda Koester BS
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  6. Brenda Sides MA
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  7. Lawrence Lenke MD
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  8. Keith Bridwell MD
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  9. Mike O’Brien MD
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  10. Harry L. Shufflebarger MD
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Corresponding author

Correspondence to Matthew J. Geek MD.

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Geek, M.J., Rinella, A., Hawthorne, D. et al. Anterior Dual Rod Versus Posterior Pedicle Fixation Surgery for the Surgical Treatment in Lenke 5C Adolescent Idiopathic Scoliosis: A Multicenter, Matched Case Analysis of 42 Patients. Spine Deform 1, 217–222 (2013). https://doi.org/10.1016/j.jspd.2013.01.002

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  • DOI: https://doi.org/10.1016/j.jspd.2013.01.002

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