Texas Scottish Rite Hospital instrumentation for correction of idiopathic scoliosis: short-term results

Abstract

In this prospective study 27 consecutive patients of an average age of 20±8 years suffering from idiopathic scoliosis were operated on using the Texas Scottish Rite Hospital (TSRH) instrumentation in the period from 1992 to 1995 and were evaluated at a minimum follow-up of 26 months postoperatively. Curvature correction, derotation of the apical vertebra, frontal and sagittal trunk balance, and L3–L4 and L4–L5 disc-space wedging were evaluated prepostoperatively and at the maximum follow-up of 54 months. The average correction of the thoracic and lumbar scolioses that was obtained immediately postoperatively averaged 41% and 51% respectively. An average 2–4° and 4–5° loss of correction was dependent on King type in the thoracic and lumbar scoliotic curves respectively was observed at the longest follow-up. Thoracic kyphosis and lumbar lordosis did not significantly change. No significant derotation of thoracic and lumbar apical vertebral rotation was achieved by TSRH but the preoperatively laterally shifted apical vertebra was translated by TSRH instrumentation towards the midline (p<0.001). The position of the T1, and C7 vertebrae in the sagital frontal plane was not significantly changed by TSRH instrumentation postoperatively. The preoperative wedging of the intervertebral spaces L3–L4 and L4–L5 was simultaneously significantly (p<0.01) reduced by TSRH with subsequent horizontalization of the L3, L4 and L5 vertebrae. No trunk decompensation, neurologic complications, infection or pseudarthroses occurred. Lumbar hook dislodgment occurred in the early post-operative period in two patients because of insufficient TSRH rod contouring at the beginning of our learning curve. TSRH is a safe instrumentation that corects idiopathic scoliosis satisfactorily, maintains frontal and sagittal vertebral balance by translating the apical vertebra towards the midline and simultaneously correcting the lowermost lumbar vertebral tilting without associated infection, neurologic complications or decompensation.