Abstract
Among posterior surgical techniques for treating adolescent idiopathic scoliosis (AIS), hybrid constructs with pedicle-screw fixation in the lumbar spine and other anchors in the thoracic spine have been reported to provide to be of more physiological value in postoperative thoracic kyphosis than all-screw constructs. The Universial Clamp (UC) equipped with a soft sublaminar band is a relatively new thoracic anchor that can be used in hybrid constructs. A dedicated reduction tool that applies traction to the sublaminar band permits gentle translation of the thoracic curve to the precontoured fusion rods, which have been previously anchored distally by pedicle screws and proximally by hooks in a claw configuration. The aim of this study was to evaluate radiographic results of AIS treatment using UC hybrid constructs. This was a prospective case series in which 29 consecutive patients with Lenke type 1, 2 or 3 AIS operated on by two surgeons in two centers were followed for 24months. Necessity for anterior release was an exclusion criterion. A total of 5.4±1.4 UCs were used per patient. The major thoracic curve was reduced from 55±7° to 14±6° at 1month and 17±6° at 24months (correction 70%) without complications. In the patients who had less than 20° of T5-T12 kyphosis preoperatively, thoracic kyphosis improved from 14±4° to 20±3° at 3months and 24±9° at 24months. In the other patients, preoperative thoracic kyphosis (27°±6°) was unchanged by the operation. UC hybrid constructs appear to safely provide satisfying coronal correction while consistently improving thoracic kyphosis in patients who also have preoperative hypokyphosis. We hypothesize that diminution in thoracic kyphosis was consistently avoided due to the straightforward traction of the spine to the fusion rods into which the chosen kyphosis was contoured by the surgeon before applying the reduction tool to the sublaminar bands.
Highlights
There is no consensus on the ideal posterior surgical technique for treating adolescent idiopathic scoliosis (AIS) [1–3]
Purpose Among posterior surgical techniques for treating adolescent idiopathic scoliosis (AIS), hybrid constructs with pedicle-screw fixation in the lumbar spine and other anchors in the thoracic spine have been reported to provide to be of more physiological value in postoperative thoracic kyphosis than all-screw constructs
We hypothesize that diminution in thoracic kyphosis was consistently avoided due to the straightforward traction of the spine to the fusion rods into which the chosen kyphosis was contoured by the surgeon before applying the reduction tool to the sublaminar bands
Summary
There is no consensus on the ideal posterior surgical technique for treating adolescent idiopathic scoliosis (AIS) [1–3]. Others prefer hybrid constructs with pediclescrew fixation in the lumbar spine but not in the thoracic spine [7, 8]. To concerns they may have over misplaced pedicle screws [9–11], proponents of hybrid constructs report postoperative thoracic kyphosis to be of more physiological value to patients than all-screw constructs [7, 8], with little difference in coronal or axial correction [12]. We have previously reported our 3-month postoperative results using hybrid constructs, including a recent system of thoracic spinal anchorage, the Universal Clamp (UC) [15]. In the 20 patients with more physiological values of preoperative thoracic kyphosis, there was no statistical difference in kyphosis after the operation. The purpose of this report was to evaluate the same group of patients to determine whether these good initial results were maintained at their 2-year follow-up visit
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