Abstract
Anterior open scoliosis surgery using the dual rod system is a safe and rather effective procedure for the correction of scoliosis (50-60%). Thoracic hypokyphosis and rib hump correction with open anterior rather than posterior instrumentation appear to be the better approaches, although the latter is somewhat controversial with current posterior vertebral column derotation devices. In patients with Risser grade 0, hyperkyphosis and adding-on may occur with anterior thoracic spine instrumentation. Anterior thoracoscopic instrumentation provides a similar correction (65%) with good cosmetic outcomes, but it is associated with a rather high risk of instrumentation (pull-out, pseudoarthrosis) and pulmonary complications. Approximately 80% of patients with adolescent idiopathic scoliosis (AIS) curves of >70° have restrictive lung disease or smaller than normal lung volumes. AIS patients undergoing anterior thoracotomy or anteroposterior surgery will demonstrate a significant decrease in percentage of predicted lung volumes during follow-up. The thoracoabdominal approach and thoracoscopic approach without thoracoplasty do not produce similar changes in detrimental lung volume. In patients with severe AIS (>90°), posterior-only surgery with TPS provides similar radiographic correction of the deformity (44%) with better pulmonary function outcomes than anteroposterior surgery. Vascular spinal cord malfunction after segmental vessel ligation during anterior scoliosis surgery has been reported. Based on the current literature, the main indication for open anterior scoliosis instrumentation is Lenke 5C thoracolumbar or lumbar AIS curve with anterior instrumentation typically between T11 and L3.
Highlights
Anterior spinal instrumentation for thoracolumbar and lumbar adolescent idiopathic scoliosis (AIS) was popularized by Dwyer [1] and Zielke [2] in the 1970s
Another advantage of anterior spinal instrumentation is its ability to correct the thoracic hypokyphosis occurring in most AIS patients [3]
Outcomes after anterior open spinal instrumentation for AIS Several studies have documented that dual rod systems provide a safe and rather effective correction of scoliosis (50–60 %) in patients with thoracic, thoracolumbar and lumbar curves (Fig. 1) [4, 6, 7]
Summary
Anterior spinal instrumentation for thoracolumbar and lumbar adolescent idiopathic scoliosis (AIS) was popularized by Dwyer [1] and Zielke [2] in the 1970s. Beginning in the 2000s, excellent outcomes were reported for thoracoscopic anterior spinal fusion and instrumentation, but the long learning curve, unfamiliarity with thoracoscopic surgery, and longer operative time have restricted its largescale use among orthopaedic surgeons During this same period, posterior pedicle screw instrumentation for both thoracic and thoracolumbar idiopathic scoliosis with. Outcomes after anterior open spinal instrumentation for AIS Several studies have documented that dual rod systems provide a safe and rather effective correction of scoliosis (50–60 %) in patients with thoracic, thoracolumbar and lumbar curves (Fig. 1) [4, 6, 7]. The largest medullary feeder of the lumbar cord is the arteria radicularis anterior magna (artery of Adamkiewicz), which in 80 % of cases originates from a left segmental
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
