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Radiographic and Functional Outcome in Adolescent Idiopathic Scoliosis Operated With Hook/Hybrid Versus All-Pedicle Screw Instrumentation—A Retrospective Study in 149 Patients

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Abstract

Study Design

Retrospective cohort study.

Objective

To compare radiographic outcome and health-related quality of life in patients with adolescent idiopathic scoliosis (AIS) treated with hook/hybrid (H/H) or all-pedicle screw (PS) instrumentation.

Summary of Background Data

PS instrumentation has largely replaced H/H in the surgical treatment of AIS but whether a normalized sagittal profile can be obtained with the PS construct is still debated. Additionally, comparative studies assessing HRQL and surgical complications are needed.

Methods

Two consecutive series of surgically treated AIS patients were included. Surgical treatment consisted of H/H or low-profile all-PS instrumentation. Radiographic and clinical follow-up, including SRS-22r questionnaires, was performed a minimum of two years postoperatively.

Results

There were 85 and 64 patients in the H/H and PS group, respectively. The groups did not differ on baseline parameters apart from a lower flexibility in the H/H group (34% ± 14% vs. 39% ± 14% in the PS group, p =.026). Mean curve correction at final follow-up was 31% ± 13% versus 49% ± 12% in the H/H and PS group, respectively (p <.001), and mean loss of correction was 7° versus 4° (p <.001). The Cincinnati correction index was significantly higher in the PS group at final follow-up (p <.001). Postoperative thoracic kyphosis was significantly higher in the H/H group (27° ± 11° vs. 22° ± 11° in the PS group) with a mean change in kyphosis of 3° ± 9° versus −3° ± 12° in the H/H and PS group, respectively. SRS-22 scores did not differ between the two groups (p >.090), and the reoperation rate at final follow-up was 9% in the H/H group and 6% in the PS group (p =.556).

Conclusions

In a large consecutive cohort of AIS patients followed for a minimum of two years, we found a significantly better curve correction and less loss of correction with PS instrumentation compared to H/H. There was no significant difference in SRS-22r scores at final follow-up.

Level of Evidence

Level III

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Author information

Authors and Affiliations

  1. Spine Unit, Department of Orthopaedic Surgery, Rigshospitalet, University of Copenhagen, Nørregade 10, 1165, København, Denmark

    Søren Ohrt-Nissen MD, Dennis W. Hallager MD, PhD, Ture Karbo MD & Martin Gehrchen MD, PhD

  2. Department of Orthopedics and Scoliosis Surgery, Texas Children’s Hospital, Houston, TX, USA

    Benny Dahl MD, PhD, DSc

Authors
  1. Søren Ohrt-Nissen MD
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  2. Dennis W. Hallager MD, PhD
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  3. Ture Karbo MD
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  4. Martin Gehrchen MD, PhD
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  5. Benny Dahl MD, PhD, DSc
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Corresponding author

Correspondence to Søren Ohrt-Nissen MD.

Additional information

Author disclosures: SO-N (grants from K2M, during the conduct of the study); DWH (grants from Globus Medical, during the conduct of the study); TK (none); MG (grants from K2M, Globus Medical, and Medtronic, during the conduct of the study); BD (grants from K2M, Globus Medical, and Medtronic, during the conduct of the study).

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Ohrt-Nissen, S., Hallager, D.W., Karbo, T. et al. Radiographic and Functional Outcome in Adolescent Idiopathic Scoliosis Operated With Hook/Hybrid Versus All-Pedicle Screw Instrumentation—A Retrospective Study in 149 Patients. Spine Deform 5, 401–408 (2017). https://doi.org/10.1016/j.jspd.2017.05.002

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  • DOI: https://doi.org/10.1016/j.jspd.2017.05.002

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