Selective Apical Convex Rod Derotation: A Fast and Secure Technique for the Correction of Adolescent Idiopathic Scoliosis-A Case Series of 38 Patients.

Abstract

We present a novel technique of selective apical convex rod derotation as an effective and safe maneuver for the correction of adolescent idiopathic scoliosis and give the clinical results of our patients. Adolescent idiopathic scoliosis is the three-dimensional deformity of the spine of more than 10° affecting children from 10 to 18 years. The gold standard for the correction of larger curves is posterior fusion. With the help of osteotomies, the spine becomes mobile and the ideal alignment can be achieved with correction maneuvers. Derotations from the concave side harvest numerous complications such as exacerbation of apical rotation, screw pullout, and implant failure. After the transpedicular screws are placed, a short titanium rod is put on the convex-side screws just covering the apex and the screw nuts are loosely tightened. The convex apical rod is held with 2 rod holders and derotation is applied to the rod and the convex spine is pulled toward the midline. After the desired correction is reached, a permanent rod is placed to the concave side and screw nuts are tightened. A total of 38 patients have been included in this study. Preoperative median Cobb angle was 47.19°, postoperative Cobb angle was measured as 18.45°, and 1 year follow-up was 17.25°. Thoracic kyphosis values were 19.07°, 30.52°, and 33.05°, respectively. Lumbar lordosis were measured as 42.63°, 43°, and 45.75°, respectively. Selective apical convex rod derotation is an effective treatment of adolescent idiopathic scoliosis with minimal risk for screw pullout, pedicular bursting, or hypokyphosis. Correction results are similar to classic correction maneuvers.