Comparative Analysis of Perioperative Differences Between Hybrid Versus Pedicle Screw Instrumentation in Adolescent Idiopathic Scoliosis

Abstract

Retrospective review of patients with adolescent idiopathic scoliosis (AIS). The objective of the study was to compare perioperative parameters and outcomes between pedicle screw and hybrid instrumentation for the treatment of AIS. Pedicle screws have been shown to allow for better correction and fewer revisions than hybrid systems. However, no study has compared perioperative parameters and their effects on patient morbidity between these 2 types of instrumentation. Fifty-six pediatric patients with AIS were included in the study. Twenty-seven patients were treated with hybrid instrumentation and 29 patients were treated with all pedicle screw (APS) instrumentation. Intraoperative and perioperative measures were compared. The mean preoperative major Cobb angle was 58.7 degrees in the hybrid group and 54.5 degrees in the APS group (P = 0.222). Patients in the hybrid group required more time in the intensive care unit (2.0 vs. 1.1 d, P = 0.041), more time to initial mobilization (5.1 vs. 2.1 d, P < 0.001), and more days using patient-controlled analgesia (5.7 vs. 4.4 d, P = 0.020). The hybrid group averaged less estimated blood loss than the APS group (619.6 vs. 947.4 mL, P = 0.011). There was no difference in surgical time (P = 0.183) or length of stay (P = 0.072) between the groups. Thoracolumbosacral orthoses were used in 81.5% of patients in the hybrid group, but in no patients in the APS group (P < 0.001). Postoperative complications occurred in 37.0% of patients in the hybrid group and 17.2% of patients in the APS group (P = 0.095). This study demonstrates several advantages of pedicle screw constructs over hybrid constructs in the surgical treatment of AIS. The benefits of pedicle screw systems extend directly to the patient and can lower the overall cost of treatment.