Abstract
ObjectiveSelecting fusion levels based on the Luk et al criteria for operative management of thoracic adolescent idiopathic scoliosis (AIS) with hook and hybrid systems yields acceptable curve correction and balance parameters; however, it is unknown whether utilizing a purely pedicle screw strategy is effective. Utilizing the fulcrum bending radiographic (FBR) to assess curve flexibility to select fusion levels, the following study assessed the efficacy of pedicle screw fixation with alternate level screw strategy (ALSS) for thoracic AIS.MethodsA retrospective study with prospective radiographic data collection/analyses (preoperative, postoperative 1-week and minimum 2-year follow-up) of 28 operative thoracic AIS patients undergoing ALSS was performed. Standing coronal/sagittal and FBR Cobb angles, FBR flexibility, fulcrum bending correction index (FBCI), trunkal shift, radiographic shoulder height (RSH), and list were assessed on x-rays. Fusion level selection was based on the Luk et al criteria and compared to conventional techniques.ResultsIn the primary curve, the mean preoperative and postoperative 1 week and last follow-up standing coronal Cobb angles were 59.9, 17.2 and 20.0 degrees, respectively. Eighteen patients (64.3%) had distal levels saved (mean: 1.6 levels) in comparison to conventional techniques. Mean immediate and last follow-up FBCIs were 122.6% and 115.0%, respectively. Sagittal alignment did not statistically differ between any assessment intervals (p>0.05). A decrease in trunkal shift was noted from preoperative to last follow-up (p = 0.003). No statistically significant difference from preoperative to last follow-up was noted in RSH and list (p>0.05). No "add-on" of other vertebra or decompensation was noted and all patients achieved fusion.ConclusionsThis is the first report to note that using the FBR for decision-making in selecting fusion levels in thoracic AIS patients undergoing management with pedicle screw constructs (e.g. ALSS) is a cost-effective strategy that can achieve clinically-relevant deformity correction that is maintained and without compromising fusion levels.
Highlights
The main goals of surgical treatment of thoracic adolescent idiopathic scoliosis (AIS) is to achieve curve correction, obtain a balanced spine, and to improve cosmesis.[1,2,3,4,5,6] As such, instrumented fusion of the spine over multiple levels for AIS is performed [7]
No "add-on" of other vertebra or decompensation was noted and all patients achieved fusion. This is the first report to note that using the fulcrum bending radiographic (FBR) for decision-making in selecting fusion levels in thoracic AIS patients undergoing management with pedicle screw constructs (e.g. alternate level screw strategy (ALSS)) is a cost-effective strategy that can achieve clinically-relevant deformity correction that is maintained and without compromising fusion levels
Studies have shown that curve flexibility and the use of pedicle screws have a predictive role in determining the degree of postoperative curve correction; thereby, contributing to selective thoracic fusion in AIS patients.[23]
Summary
The main goals of surgical treatment of thoracic adolescent idiopathic scoliosis (AIS) is to achieve curve correction, obtain a balanced spine, and to improve cosmesis.[1,2,3,4,5,6] As such, instrumented fusion of the spine over multiple levels for AIS is performed [7]. The long fusion block may increase stress at the adjacent non-fused level, which may lead to degenerative changes (e.g. narrowing of the lumbar disc spaces, sclerosis of the endplate and facet joints, osteophyte formation) in spinal segments beneath fusion may occur and subsequent back pain. This methodology was not based on "curve flexibility" or the use of pedicle screw fixation strategies. Studies have shown that curve flexibility and the use of pedicle screws have a predictive role in determining the degree of postoperative curve correction; thereby, contributing to selective thoracic fusion in AIS patients.[23]
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