Abstract
Last two decades witnessed great advances in the surgical treatment of idiopathic scoliosis. However, the number of studies evaluating the long-term results of these treatment methods is relatively low. During recent years, besides radiological and clinical studies, questionnaires like SRS-22 assessing subjective functional and mental status and life-quality of patients have gained importance for the evaluation of these results. In this study, surgical outcome and Turkish SRS-22 questionnaire results of 109 late-onset adolescent idiopathic scoliosis patients surgically treated with third-generation instrumentation [Texas Scottish Rite Hospital (TSRH) System] and followed for a minimum of 10 years were evaluated. The balance was analyzed clinically and radiologically by the measurement of the lateral trunk shift (LT), shift of head (SH), and shift of stable vertebra (SS). Mean age of the patients was 14.4±1.9 and mean follow-up period was 136.9±12.7 months. When all the patients were included, the preoperative mean Cobb angle of major curves in the frontal plane was 60.8°±17.5°. Major curves that were corrected by 38.7±22.1% in the bending radiograms, postoperatively achieved a correction of 64.0±15.8%. At the last follow-up visit, 10.3°±10.8° of correction loss was recorded in major curves in the frontal plane with 50.5±23.1% final correction rate. Also, the mean postoperative and final kyphosis angles and lumbar lordosis angles were 37.7°±7.4°, 37.0°±8.4°, 37.5°±8.7°, and 36.3°±8.5°, respectively. A statistically significant correction was obtained at the sagittal plane; mean postoperative changes compared to preoperative values were 7.9° and 12.9° for thoracic and lumbar regions, respectively. On the other hand, normal physiological thoracic and lumbar sagittal contours were achieved in 83.5% and 67.9% of the patients, respectively. Postoperatively, a statistically significant correction was obtained in LT, SH, and SS values (P<0.05). Although, none of the patients had completely balanced curves preoperatively, in 95.4% of the patients the curves were found to be completely balanced or clinically well balanced postoperatively. This rate was maintained at the last follow-up visit. Overall, four patients (3.7%) had implant failure. Early superficial infection was observed in three (2.8%) patients. Radiologically presence of significant consolidation, absence of implant failure, and correction loss, and clinical relief of pain were considered as the proof of a posterior solid fusion mass. About ten (9.2%) patients were considered to have pseudoarthrosis: four patients with implant failure and six patients with correction loss over 15° at the frontal plane. About four (3.7%) patients among the first 20 patients had neurological deficit only wake-up test was used for neurological monitoring of these patients. No neurological deficit was observed in the 89 patients for whom intraoperative neurological monitoring with SSEP and TkMMEP was performed. Overall, average scores of SRS-22 questionnaire for general self-image, function, mental status, pain, and satisfaction from treatment were 3.8±0.7, 3.6±0.7, 4.0±0.8, 3.6±0.8, and 4.6±0.3, respectively at the last follow-up visit. Results of about 10 years of follow-up these patients treated with TSRH instrumentation suggest that the method is efficient for the correction of frontal and sagittal plane deformities and trunk balance. In addition, it results in a better life-quality.
Similar content being viewed by others
References
Alanay A, Cil A, Berk H, Acaroğlu RA, Yazıcı M, Akcalı O, Kosay C, Genc Y, Surat A (2005) Reliability and validity of adapted Turkish version of Scoliosis Research Society-22 (SRS-22) questionnaire. Spine 30 (in press)
Antuno SA, Mendez JG, Lopez-Fanjul JC, Paz-Jimenez J (1997) Cotrel-dubousset instrumentation in idiopathic scoliosis at 5-year follow-up. Acta Orthop Belg 63:74–81
Ashman RB, Herring JA, Johnston CE (1992) Texas Scottish Rite Hospital (TSRH) instrumentation system. In: Bridwell KH, DeWald R (eds) The textbook of spinal surgery. JB Lippincott Co., Philadelphia, pp 219–248
Asher M, Min Lai S, Burton D, Manna B (2002) Spine deformity corraletes beter than trunk deformity with idiopathic scoliosis patients’ quality of life questionnaire responses. Stud Health Technol Inform 91:462–464
Asher M, Min Lai S, Burton D, Manna B (2003) The reliability and concurrent of the scoliosis research society—22 patient questionnaires for idiopathic scoliosis. Spine 28(1):36–69
Asher M, Min Lai S, Burton D, Manna B (2003) Scoliosis research society—22 patient questionnaire: responsiveness to change associated with surgical treatment. Spine 28(1):70–73
Asher M, Min Lai S, Burton D, Manna B (2003) Discrimination validity of the scoliosis research society—22 patient questionnaire: relationship to idiopathic scoliosis curve pattern and curve size. Spine 28(1):74–78
Asher M, Min Lai S, Burton D, Manna B (2004) The influence of spine and trunk deformity on preoperative idiopathic scoliosis patients’ health-related quality of life questionnaire responses. Spine 29(8):861–868
Asher M, Lai SM, Burton D, Manna B, Cooper A (2004) Safety and efficacy of Isola instrumentation and arthrodesis for adolescent idiopathic scoliosis: two- to 12-year follow-up. Spine 29(18):2013–2023
Bago J, Climent JM, Ey A, Perez-Grueso FJ, Izquierdo E (2004) The spanish version of the SRS-22 patient questionnaire for idiopatic scoliosis: transcultural adaptation and reliability analysis. Spine 29(15):1676–1680
Benli IT, Akalin S, Tuzuner MM, Tandogan NR, Citak M, Mumcu EF (1994) Three-dimensional analysis treated with Cotrel-Dubousset Instrumentation. GICD’93, Sauramps Medical, Montpellier, pp 26–35
Benli IT, Tuzuner M, Akalin S, Kis M, Aydin E, Tandogan R (1996) Spinal imbalance and decompensation problems in patients treated with Cotrel-Dubousset instrumentation. Eur Spine J 5:380–386
Benli IT, Akalın S, Kıs M, Cıtak M, Aydın E, Duman E (2001) Frontal and sagittal balance analysis of late onset idiopathic scoliosis treated with third generation instrumentation. Kobe J Med Sci 47:231–253
Bridwell KH, Betz R, Capelli AM, Hum G, Harvey C (1989) Sagittal plane analysis in idiopathic scoliosis patients treated with Cotrel-Dubousset instrumentation. In: Sixth International Congress on CDI, Sauramps Medical, Montpellier, pp 65–71
Bridwell KH (1994) Spine update. Surgical treatment of adolescent idiopathic scoliosis: the basics and the controversies. Spine 19:1095–1100
Bridwell KH (1997) Spinal instrumentation in management of adolescent idiopathic scoliosis. Clin Orthop Rel Res 335:64–72
Bridwell KH, Hanson DS, Rhee JM, Lenke LG, Baldus C, Blanke K (2002) Correction of thoracic adolescent idiopathic scoliosis with segmental hooks, rods, and Wisconsin wires posteriorly: it’s bad and obsolete, correct? Spine 27(18):2059–2066
Chopin D, Morin C (1992) Cotrel-Dubousset instrumentation (CDI) for adolescent and pediatric scoliosis. In: Bridwell KH, DeWald RL (eds) The textbook of spinal surgery. JB Lippincott Company, Philadelphia, pp 183–217
Delorme S, Labelle H, Poitras B, Rivard CH, Coillard C, Dansereau J (2000). Pre-, intra-, and postoperative three-dimensional evaluation of adolescent idiopathic scoliosis. J Spinal Disord 13(2):93–101
Dubousset J, Cotrel Y (1991) Application technique of Cotrel-Dubousset instrumentation for scoliosis deformities. Clin Orthop Rel Res 264:103–110
Gotze C, Liljenqvist UR, Slomka A, Gotze HG, Steinbeck J (2002) Quality of life and back pain: outcome 16.7 years after Harrington instrumentation. Spine 27(13):1456–1463
Haher TR, Merola A, Zipnick RI, Gorup J, Mannor D, Orchowski J (1995) Meta-analysis of surgical outcome in adolescent idiopathic scoliosis. A 35-year English literature review of 11,000 patients. Spine 20(14):1575–1584
Haher TR, Gourup JM, Shin TM, Homel P, Merola AA, Grogan DP, Pugh L, Lowe TG, Murray M (1999) Results of the scoliosis research society instrument for evaluation of surgical outcome in adolescent idiopathic scoliosis. A multicenter study of 244 patients. Spine 24(14):1435–1440
Helenius I, Remes V, Yrjonen T, Ylikoski M, Schlenka D, Helenius M, Poussa M (2002) Comparison of long-term functional and radiologic outcomes after Harrington instrumentation and spondylodesis in adolescent idiopathic scoliosis: a review of 78 patients. Spine 27(2):176–180
Herring JA (2002) Tachdjian’s pediatric orthopaedics, 3rd edn. WB Saunders Company, Philadelphia, pp 326
Jeng CL, Sponseller PD, Tolo VT (1993) Outcomes of wisconsin instrumentation in idiopathic scoliosis. Minimum 5-year follow-up. Spine 18(12):1584–1590
King HA (1988) Selection of fusion levels for posterior instrumentation and fusion in idiopathic scoliosis. Orthop Clin North Am 19:247–55
Labelle H, Dansereau J, Bellefleur C, Poitras B, Rivard CH, Stokes IA, DeGuise J (1995). Comparison between preoperative and postoperative three –dimensional reconstructions of iddiopathic scoliosis with the Cotrel-Dubousset procedure. Spine 20(23):2487–2492
Lepsien U, Bullmann V, Hackenberg L, Liljenqvist U (2002) Long-term results of posterior correction and fusion of scoliosis using the Cotrel-Dubousset instrumentation. Z Orthop Ihre Grenzgeb 140(1):77–82 (abstract)
Mason DE, Carango P (1991) Spinal decompensation in Cotrel-Dubousset instrumentation. Spine 16:S394–S403
Merola AA, Haher TR, Brkariç M, Panagopoulos G, Mothur S, Kohani U, Lowe TG, Lenke LG, Wenger DR, Newton PO, Clements DH, Betz RR (2002) A multicenter study of the outcomes of the surgical treatment of adolescent idiopathic scoliosis using the scoliosis research society (SRS) outcome instrument. Spine 27(18):2046–2051
Padua R, Padua S, Aulisa S, Ceccarelli E, Padua L, Romanini E, Zanoli G, Campi A (2001) Patient outcomes after Harrington instrumentation for idiopathic scoliosis: a 15- to 28- year evaluation. Spine 26(11):1268–1273
Perez-Grueso FS, Fernandez-Baillo N, Arauz de Robles S, Garcia Fernandez A (2000) The low lumbar spine below Cotrel-Dubousset instrumentation: long term findings. Spine 25(18):2333–2341
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(18):2024–2030
Rhee JM, Bridwell KH, Won DS, Lenke LG, Chotigavanichaya C, Hanson DS (2002) Sagittal plane analysis of adolescent scoliosis: the effect of anterior versus posterior instrumentation. Spine 27(21):2350–2356
Richards BS, Birch JG, Herring JA, Johnston CE, Roach JW (1989) Frontal plane and sagittal plane balance following Cotrel-Dubousset instrumentation for idiopathic scoliosis. Spine 14:733–737
Richards BS, Herring JA, Johnston CE, et al (1994) Treatment of adolescent idiopathic scoliosis using Texas Scottish rite hospital instrumentation. Spine 19:1598–1605
Rinella A, Lenke L, Peelle M, Edwards C, Bridwell KH, Sides B (2004) Comparison of SRS questionnaire results submitted by both parents and patients in the operative treatment of idiopathic scoliosis. Spine 29(3):303–310
Sawatzky BJ, Tredwell SJ, Jang SB, Black AH (1998) Effect of three-dimensional assessment on surgical correction and hook strategies in multi-hook instrumentation for adolescent idiopathic scoliosis. Spine 23:201–205
Shufflebarger JL, Crawford AH (1988) Is Cotrel-Dubousset instrumentation the treatment of choice for idiopathic scoliosis in the adolescent who has an operative thoracic curve? Orthopaedics 11:1579–1588
Takahashi S, Delecrin J, Passuti N (1997) Changes in the unfused lumbar spine in patients with idiopathic scoliosis. A 5- to 9-year assessment after Cotrel-Dubousset instrumentation. Spine 22(5):517–523
Thompson GH, Willbur RE, Shaffer JW, et al (1985) Segmental spinal instrumentation in idiopathic scoliosis: a preliminary report. Spine 10:623–630
Thompson JP, Transfeldt EE, Bradford DS, Ogilvie JW, Boachie-Adjei O (1990) Decompensation after Cotrel-Dubousset instrumentation of idiopathic scoliosis. Spine 15:927–931
Transfeldt E, Thompson J, Bradford D (1989) Three dimensional changes in the spine following CDI for adolescent idiopathic scoliosis. In: Proceedings of the 6th international congress on Cotrel-Dubousset instrumentation, Sauramps Medical, Montpellier, pp 73–80
White SF, Asher MA, Lai SM, Burton DC (1999) Patients’ perceptions of overall function, pain, and appearanca after primary posterior instrumentation and fusion for idiopathic scoliosis. Spine 24(16):1693–1699
White SF, Asher MA, Lai SM, Burton DC (1999) Patients’ perception of overall function, pain, and appearance after primary posterior instrumentation and fusion for idiopathic scoliosis. Discussion. Spine 24(16):1699–1700
Willers U, Hedlund R, Aaro S, Normelli H, Westman L (1993) Long-term results of Harrington instrumentation in idiopathic scoliosis. Spine 18(6):713–717
Wood KB, Obewski JM, Schendel MS, Boachie-Adjei O, Gupta M (1997) Rotational changes of the vertebral pelvis axis after sublaminar instrumentation in adolescent idiopathic scoliosis. Spine 22:51–57
Acknowledgments
The authors thank John A. Herring M.D. for helpful review and Joanna Husouski and Nur Sozudogru for professional editing of our manuscript.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Benli, İ.T., Ates, B., Akalin, S. et al. Minimum 10 years follow-up surgical results of adolescent idiopathic scoliosis patients treated with TSRH instrumentation. Eur Spine J 16, 381–391 (2007). https://doi.org/10.1007/s00586-006-0147-3
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-006-0147-3