Anterior Scoliosis Correction Research Articles

Results of anterior scoliosis correction (ASC) in adult idiopathic scoliosis: Analysis of early outcomes and 2-year follow-up

Results of anterior scoliosis correction (ASC) in adult idiopathic scoliosis: Analysis of early outcomes and 2-year follow-up

CLINICAL AND RADIOLOGICAL OUTCOME OF LENKE V ADOLESCENT IDIOPATHIC SCOLIOSIS VIA THE ANTERIOR APPROACH

Adolescent idiopathic scoliosis is a three-dimensional deformity of the spine, affecting 1–3% of the population.Most cases are treated conservatively. Curves exceeding 45° in the thoracic spine and 40° in the lumbar spine may require correction and fusion surgery, to limit the progression of the curve and prevent restrictive pulmonary insufficiency (curves above 70°). When fusion is required, it may be performed either by posterior or anterior approaches. Posterior is useful for thoracic (Lenke I) curves, notably to correct the thoracic hypokyphosis frequently observed in AIS. Anterior approaches by thoraco-lombotomies allow an effective correction of thoraco-lumbar and lumbar curves (Lenke V and VI), with fewer levels fused than with posterior approaches. However, the approach requires diaphragm splitting and one may be concerned about the long-term pulmonary consequences. The literature provides conflicting insight regarding the consequences of the approach in anterior scoliosis correction, the interpretation of the results being difficult knowing that the correction of the scoliosis itself may improve pulmonary function.This is a retrospective observational study done at a Tertiary Institution. The HRQOL scores have been collected as a prospective cohort. Clinical and radiographic data was collected from patients charts and analysed by two senior surgeonsA cohort of 64 patients were operated in the given time period. 50 patients met the inclusion criteria. No major complications were reported. The Union rate was 100% and no post operative complications were noted. Pre and post SRS scores improved in all patients.The Anterior approach for Lenke V AIS gives great surgical exposure and allows for excellent correction of Cobb angle with minimal risk to the patient.

Are We Looking at a Paradigm Shift in the Management of Adolescent Idiopathic Scoliosis? Comprehensive Retrospective Analysis of 75 Patients of Nonfusion Anterior Scoliosis Correction with 2-5-Year Follow-up: A Single Center Experience.

Retrospective cohort study. This study aimed to evaluate the clinical and radiological outcomes of nonfusion anterior scoliosis correction (NFASC) in patients with idiopathic scoliosis and comprehensively analyze its principles. NFASC is a novel revolutionary motion-preserving surgery for idiopathic scoliosis. However, clinical data related to this procedure remain scarce, with no conclusive guidelines regarding case indications, proper technique, and possible complications. This study included patients with adolescent idiopathic scoliosis (AIS) who were treated with NFASC for a structural major curve (Cobb angle, 40°-80°) with more than 50% flexibility on dynamic X-rays. The mean follow-up was 26±12.2 months (range, 12- 60 months). Clinical and radiological data such as skeletal maturity, curve type, Cobb angle, surgery details, and Scoliosis Research Society-22 revised (SRS-22r) questionnaire were collected. Statistically significant trends were examined by post hoc analysis following repeated measures analysis of variance test. A total of 75 patients (70 females, five males) were included, with a mean age of 14.96±2.69 years. The mean Risser and Sanders scores were 4.22±0.7 and 7.15±0.74, respectively. The mean main thoracic Cobb angles at the first and second follow-up (17.2°±5.36° and 16.92°±5.06°, respectively) were significantly lower than the preoperative Cobb angles (52.11°±7.74°) (p <0.05). Similarly, the mean thoracolumbar/lumbar Cobb angle significantly improved from the preoperative period (51.45°±11.26°) to the first follow-up (13.48°±5.11°) and last follow-up (14.24°±4.85°) (p <0.05). The mean preoperative and postoperative SRS-22r scores were 78.0±3.2 and 92.5±3.1, respectively (p <0.05). None of the patients had any complications until the most recent follow-up. NFASC offers promising curve correction and curve progression stabilization in patients with AIS, with a low risk for complications and preservation of spinal mobility and sagittal parameters. Thus, it proves to be a favorable alternative to fusion modality.

RETROSPECTIVE MATCHED COMPARISON STUDY ON NON FUSION ANTERIOR SCOLIOSIS CORRECTION (NFASC) VERSUS POSTERIOR SPINAL FUSION (PSF) FOR LENKE 5 ADOLESCENT IDIOPATHIC SCOLIOSIS (AIS) CURVES IN SKELETALLY MATURE CHILDREN: CLINICO-RADIOLOGICAL OUTCOMES WITH TWO YEARS’ FOLLOW-UP

The current study aims to compare the clinico radiological outcomes between Non-Fusion Anterior Scoliosis (NFASC) Correction and Posterior Spinal Fusion (PSF) for Lenke 5 curves at 2 years follow up.Methods:38 consecutive Lenke 5 AIS patients treated by a single surgeon with NFASC (group A) or PSF (group B) were matched by age, Cobb's angle, and skeletal maturity. Intraoperative blood loss, operative time, LOS, coronal Cobbs, and SRS22 scores at 2 years were compared. Flexibility was assessed by modified Schober's test. Continuous variables were compared using student t-tests and categorical variables were compared using chi-square.The cohort included 19 patients each in group A and B . Group A had M:F distribution of 1:18 while group B had 2:17. The mean age in group A and group B were 14.8±2.9 and 15.3±3.1 years respectively. The mean follow-up of patients in groups A and B were 24.5±1.8 months and 27.4±2.1 months respectively. Mean pre-op thoracolumbar/lumbar (TL/L) cobbs for group A and group B were 55°±7° and 57.5°±8° respectively. At two years follow up, the cobbs for group A and B were 18.2°±3.6° and 17.6°±3.5° respectively (p=0.09). The average operating time for groups A and B were 169±14.2 mins and 219±20.5 mins respectively (p&lt;0.05). The average blood loss of groups A and B were 105.3±15.4 and 325.3±120.4 respectively (p&lt;0.05). The average number of instrumented vertebra between groups A and B were 6.2 and 8.5 respectively (p&lt;0.05). The average LOS for NFASC and PSF was 3.3±0.9 days and 4.3±1.1 days respectively (p&lt;0.05). No statistically significant difference in SRS 22 score was noted between the two groups. No complications were recorded.Our study shows no significant difference in PSF and NFASC in terms of Cobbs correction and SRS scores, but the NFASC group had significantly reduced blood loss, operative time, and fewer instrumented levels. NFASC is an effective alternative technique to fusion to correct and stabilize Lenke 5 AIS curves with preservation of spinal motion.

EFFECT OF ENHANCE RECOVERY PATHWAY (ERP) RESULTING IN REDUCED LENGTH OF STAY AND OPIOID CONSUMPTION AFTER NON FUSION ANTERIOR SCOLIOSIS CORRECTION (NFASC) SURGERY FOR ADOLESCENT IDIOPATHIC SCOLIOSIS (AIS): A SINGLE-CENTRE EXPERIENCE

The current study aims to find the role of Enhance Recovery Pathway (ERP) as a multidisciplinary approach aimed to expedite rapid recovery, reduce LOS, and minimize morbidity associated with Non Fusion Anterior Scoliosis Correction (NFASC) surgery.A retrospective analysis of 35 AIS patients who underwent NFASC with Lenke 1 and Lenke 5 curves with a minimum of 1 year of follow-up was done. Patient demographics, surgical details, postoperative analgesia, mobilization, length of stay (LOS), patient satisfaction survey score with respect to information and care, and 90 days complications were collected.The cohort included 34 females and 1 male with a mean age of 15.2 years at the time of surgery. There were 16 Lenke 1 and 19 Lenke 5 in the study. Mean preoperative major thoracic and thoracolumbar/lumbar Cobb's angle were 52˚±7.6˚ and 51˚±4.5˚ respectively. Average blood loss and surgical time were 102 ±6.4 ml and 168 ± 10.2 mins respectively. Average time to commencing solid food was 6.5±1.5 hrs. Average time to mobilization following surgery was 15.5± 4.3 hrs. The average duration to the stopping of the epidural was 42.5±3.5 hrs. The average dose of opioid consumption intraoperatively was 600.5±100.5 mcg of fentanyl i.v. and 12.5±4.5 mg morphine i.v. Postoperatively opioids were administered via an epidural catheter at a dose of 2 mg of morphine every 24 hours up to 2 days and an infusion of 2mcg/hr of fentanyl along with 0.12-0.15% ropivacaine. The average duration to transition to oral analgesia was 55.5±8.5 hrs .20 patients had urinary catheter and the average time to removal of the catheter was 17.5±1.4 hrs. 25 patients had a chest tube and the average time to remove of chest tube was 25.5±3.2 hrs. The average length of hospital stay was 3.1±0.5 days. No patient had postoperative ileus or requirement of blood transfusion or any other complications. No correlation was found between LOS and initial cobb angle.The application of ERP in AIS patients undergoing NFASC results in reduced LOS and indirectly the cost, reduced post-operative opioid use, and overall improve patient satisfaction score.

The different applications of Vertebral Body Tethering - Narrative review and clinical experience

BackgroundVertebral body tethering (VBT) has been originally developed as a growth modulation technique for the surgical management of skeletally immature patients with adolescent idiopathic scoliosis (AIS). Given the positive results obtained in this setting, the use of VBT is gradually expanding to other patient categories, such as those with no or limited remaining growth or with non-idiopathic scoliosis. Aim of this manuscript is to offer an overview over the current applications of VBT, along with imaging and comments derived from the clinical experience. The work was based on a literature search conducted in January 2023 on Pubmed, Scopus and Web of Science databases. Following keywords were used for the search: vertebral body tethering, adolescent idiopathic scoliosis, early onset scoliosis, neuromuscular scoliosis, syndromic scoliosis. ResultsThree patient categories in which VBT has been applied have been highlighted: VBT for growth modulation in AIS, VBT as anterior scoliosis correction in AIS and VBT for non-idiopathic curves or early-onset scoliosis. ConclusionWhile growth modulation in AIS still represents the most widespread use of VBT, the use of this technique has yielded positive results in different settings as well, such as scoliosis correction in AIS or temporary or definitive curve management in non-AIS curves. While long-term results are lacking, patient selection seems to play a central role to reduce the complication rate and ensure predictable and stable results.

Retrospective Review of Double Screw/Double Cord Anterior Scoliosis Correction (ASC) with Thoracic Disc Releases for Thoracic Curves &gt; 65 Degrees: Surgical Techniques and Outcomes

Retrospective Review of Double Screw/Double Cord Anterior Scoliosis Correction (ASC) with Thoracic Disc Releases for Thoracic Curves &gt; 65 Degrees: Surgical Techniques and Outcomes

Analysis of factors influencing tether breakage following non fusion anterior scoliosis correction (NFASC) in adolescent idiopathic scoliosis (AIS)- A single centre experience

Analysis of factors influencing tether breakage following non fusion anterior scoliosis correction (NFASC) in adolescent idiopathic scoliosis (AIS)- A single centre experience

Dual modality of vertebral body tethering : anterior scoliosis correction versus growth modulation with mean follow-up of five years.

AimsVertebral body tethering (VBT) is a non-fusion technique to correct scoliosis. It allows correction of scoliosis through growth modulation (GM) by tethering the convex side to allow concave unrestricted growth similar to the hemiepiphysiodesis concept. The other modality is anterior scoliosis correction (ASC) where the tether is able to perform most of the correction immediately where limited growth is expected.MethodsWe conducted a retrospective analysis of clinical and radiological data of 20 patients aged between 9 and 17 years old, (with a 19 female: 1 male ratio) between January 2014 to December 2016 with a mean five-year follow-up (4 to 7).ResultsThere were ten patients in each group with a total of 23 curves operated on. VBT-GM mean age was 12.5 years (9 to 14) with a mean Risser classification of 0.63 (0 to 2) and VBT-ASC was 14.9 years (13 to 17) with a mean Risser classification of 3.66 (3 to 5). Mean preoperative VBT-GM Cobb was 47.4° (40° to 58°) with a Fulcrum unbend of 17.4 (1° to 41°), compared to VBT-ASC 56.5° (40° to 79°) with 30.6 (2° to 69°)unbend. Postoperative VBT-GM was 20.3° and VBT-ASC Cobb angle was 11.2°. The early postoperative correction rate was 54.3% versus 81% whereas Fulcrum Bending Correction Index (FBCI) was 93.1% vs 146.6%. The last Cobb angle on radiograph at mean five years’ follow-up was 19.4° (VBT-GM) and 16.5° (VBT-ASC). Patients with open triradiate cartilage (TRC) had three over-corrections. Overall, 5% of patients required fusion. This one patient alone had a over-correction, a second-stage tether release, and final conversion to fusion.ConclusionWe show a high success rate (95%) in helping children avoid fusion at five years post-surgery. VBT is a safe technique for correction of scoliosis in the skeletally immature patient. This is the first report at five years that shows two methods of VBT can be employed depending on the skeletal maturity of the patient: GM and ASC.Cite this article: Bone Jt Open 2022;3(2):123–129.

Treatment for an Adult Patient with Slowly Progressive Idiopathic Scoliosis Using a Unique Anterior Scoliosis Correction Technique: A Case Report

Adolescent idiopathic scoliosis (AIS) can continue to progress after skeletal maturity. Once the progression is severe, posterior spinal fusion (PSF) is the gold standard for surgical treatment. While effective in achieving curve correction, PSF is associated with many problems, including loss of spinal flexibility, uncorrected sagittal deformity, and adjacent segment disease. We present a case of a 50-year-old woman with a documented 38º thoracic curve as a late teen who experienced curve progression after skeletal maturity to &gt;70 ° and underwent Anterior Scoliosis Correction (ASC), a motion-preserving scoliosis correction surgery. Her progressive curve improved from 71º Lenke 1A main thoracic curve to 28°, with a 59% correction being maintained within 5° (33°) at 7 years. She also obtained a 50% correction of her compensatory lumbar curve and correction of hypokyphosis from 2.4° to 23° at 7 years. Along with improvement of her thoracic kyphosis, her lumbar lordosis decreased to a normal range of 60° from 70°, giving her better overall alignment. This case report suggests that motion preserving surgical treatment may be considered for some select adult patients with progressive scoliosis. Key Words: Progressive Scoliosis, Anterior Scoliosis Correction

Assessing clinical trunk change with surface topography: anterior scoliosis correction as a model to evaluate curve progression.

Previous work has suggested that surface topography can be used for repeated measurements of deformity during curve monitoring following an initial radiograph. Changes in deformity during natural curve progression may be subtle. An important preemptive question to answer is whether topography can follow a large change in spine deformity, as in scoliosis correction. We assess the ability of surface topography to track the evolution of spine deformity during anterior scoliosis correction relative to traditional radiographs. Anterior scoliosis correction was chosen for this analysis because it changes the shape of the trunk without leaving a surgical scar and muscle atrophy along the posterior spine. Following IRB approval, 18 patients aged 14.6 ± 2.0years at surgery were enrolled in a retrospective review of coronal radiographs and topographic scans acquired before and after scoliosis correction. Radiographic and topographic measures for the coronal curve angle before and after surgery were compared. Surface topography estimates correlate with radiographic measures of the pre- (r = 0.7890, CI = [0.4989 0.9201], p < 0.00001), postsurgical (r = 0.7485, CI = [0.4329 0.9006], p = 0.0004), and the change in the coronal curve angle (r = 0.6744, CI = [0.3028 0.8680], p = 0.0021) due to surgery. We provide evidence open for further extension that topography can follow changes in the coronal curve angle comparably to radiographs. Level IV.

The first experience of anterior dynamic correction of scoliosis in adolescents with complete growth and adults: surgical technique and immediate results

Objective. To describe the technique of anterior scoliosis correction in patients with completed growth and to analyze immediate results of its application.Material and Methods. Study design: retrospective clinical series. Level of evidence IV (D). A retrospective analysis of clinical and radiological data of 19 patients aged 13–44 years, who underwent anterior dynamic correction of typical idiopathic scoliosis, was performed. Patients were divided into groups as follows: Group 1 (Lenke type 1 scoliosis) – 8 patients; Group 2 (Lenke 3) – 4 patients; and Group 3 (Lenke 5) – 7 patients. When analyzing clinical and radiological data, the age was taken into account; the deformity magnitude before and after surgery, and correction angle, were studied; and intraoperative blood loss, the number of fixed levels, duration of surgery and hospital stay length were evaluated. The functional status was assessed using the VAS and the SRS-22 questionnaire. Control examinations were carried out before and after surgery as well as at 4–6 weeks and 3, 6, and 12 months after surgery. The search for statistically significant differences was carried out between all groups in pairs: between groups 1 and 2, 2 and 3, and 1 and 3. Statistical analysis was conducted using Mann – Whitney U-test. The SRS-22 and VAS data were processed using the Wilcoxon W-test.Results. The number of dynamically fixed levels varied from 6 to 12. The most proximal level of fixation was T5, the most distal – L4. The average time of surgery was 181 ± 28 minutes for transthoracic access and 198 ± 34 minutes for thoracophrenolumbotomy. The average length of hospital stay was 7.2 ± 1.5 days. In the intergroup comparison of indicators of age, mean angle of deformity before and after surgery, mean angle of correction and blood loss between groups with Lenke 1 and 3 scoliosis, no statistically significant differences were found. Comparison of the same indicators for groups with Lenke 1 and 5 scoliosis showed significant differences in the angles of deformity after surgery and in the number of fixed levels (p = 0.024 and p = 0.006, respectively). There were also no statistical differences between types 1 and 5. At 3 months after surgery the average SRS-22 score for all patients was 4.0 ± 0.42 (from 3.00 to 4.95). The VAS score changed from 6.9 ± 1.5 (4.0–9.0) before surgery to 4.4 ± 1.6 (1.0–7.0) which indicates the effectiveness of the treatment in the short term.Conclusion. Analysis of the immediate results of anterior dynamic correction of Lenke type 1, 3 and 5 scoliotic deformities in physically active young adults showed positive primary effectiveness in terms of VAS and SRS-22, which makes it possible to recommend this technique for use in the presented cohort of patients. The method is effective for all studied types of scoliosis, with a greater efficiency in Lenke types 1 and 5. Further evaluation of long-term results on a larger clinical material will allow developing more precise indications and an algorithm for application of the method.

Anterior dynamic scoliosis correction in a patient with congenital left-sided false diaphragmatic Bohdalek hernia: one-stage surgical solution

A clinical case of treatment of lumbar scoliotic deformity combined with false congenital diaphragmatic hernia in a 17-year-old patient is presented. Stage surgical solution to the problem was achieved using dynamic scoliosis correction system installed through the anterior approach.

Radiographic Results after Vertebral Body Tethering.

Vertebral body tethering (VBT), otherwise known as fusion-less anterior scoliosis correction (ASC), is a new and increasingly interesting therapeutic option for selected scoliosis patients. The available data on this surgical technique are still limited and guidelines on patient selection or surgical timing are not available. The aim of this study was to conduct a systematic review of the available literature on VBT. The analysis was performed in accordance with the PRISMA Statement. Nine studies with data from 175 patients were available. On average, 7.3 vertebrae were instrumented. Surgical time was 230 min and the estimated blood loss 153 ml. The mean correction on the coronal plane was 52%, and there was no significant change in sagittal parameters. The revision rate was 18.9%. The methodological quality assessment with the Coleman score gave unsatisfactory results, so that available data are not sufficient to propose general indications or guidelines to perform VBT.

Reducing the kyphosis effect of anterior short thoracolumbar/lumbar scoliosis correction with an autograft fulcrum effect

BackgroundAnterior scoliosis correction is a powerful technique with the disadvantage of a kyphotic effect on lumbar and thoracolumbar curves. We aimed to investigate whether a cognizant interposition of a rib graft anteriorly and at the concave side of the scoliotic curve causes significant fulcrum effect to enforce scoliosis correction and to reduce interfusional kyphosis in anterior scoliosis corrections.MethodsTwenty otherwise comparable patients with lumbar and thoracolumbar adolescent idiopathic scoliosis (AIS) curves undergoing anterior short scoliosis correction with (n = 10) or without (n = 10, matched for age, gender and degree of deformity) fulcrum effect were retrospectively compared by means of radiographic measurements (sagittal and coronal profile, Cobb angles and intersegmental deformity correction angles) to evaluate the effect of this modified surgical technique.ResultsThe overall amount of scoliosis correction was similar with 74 and 60% of initial curves of 57° and 53° in the case and control group respectively with a mean of 3 fused segments (4 screws).Statistically relevant differences were found for intersegmental coronal cobb angles at the apex of 20° to 3° and 17° to 9° with and without fulcrum, respectively (p < 0.05). Creation of kyphosis in the fused segments was reduced with an interfusional kyphotic sagittal cobb angle of 15° pre-operatively vs. 3° post-operatively compared to the control group (13° pre-operatively vs. 18° post-operatively), (p < 0.05).ConclusionsInterfusional hyperkyphosis associated with anterior scoliosis correction for thoracolumbar/lumbar curves can be reduced with cognizant positioning of the bone autograft at the antero-lateral (concave) site in the intervertebral region to create a fulcrum effect.Trial registrationRegistered at swissethics: BASEC No.: 2018–00180.

Treatment of Mature/Maturing Patients with Adolescent Idiopathic Scoliosis (Sanders ≥ 5) Using a Unique Anterior Scoliosis Correction Technique

Anterior vertebral body tethering (VBT) in growing children has been reported as an alternative to fusion for thoracic idiopathic scoliosis. Anterior scoliosis correction (ASC) is our multi-year, multi-generational advancement upon VBT and is a “de-tethering,” not tethering, procedure. ASC incorporates cords/screws similarly to VBT but is a technique that allows for large derotation, curve correction, and restoration of kyphosis using anterior longitudinal ligament complex release (ligament, annular capsule, and disc). It has been used to treat adolescents with minimal or no growth remaining. In this retrospective IRB-approved analysis, we report outcomes of an early cohort of skeletally maturing/mature (Sanders ≥ 5) patients undergoing ASC. Methods: Inclusion criteria: patients with AIS, at least one operative curve 35-70°, Sanders ≥ 5, age ≤ 21 years, minimum 2-year follow-up or failure before. Forty-nine patients with 82 treated curves with surgery from January 2015 to December 2017 met the criteria and were reviewed. Mean follow-up was 30.3 months range 24 to 50 months. Average age at surgery was 15.2 years. Results: The average coronal correction was 65.5% for thoracic curves and 66.7% for lumbar curves. 71.4% of patients with thoracic curves received at least 1 thoracic disc release. Kyphosis (T5-T12) calculated 3D corrected from average 2° pre to 34° post-op. Clinical success (final curve ≤ 30°) was achieved in 45/49 (92%) patients and in 78/82 curves (95%). One unanticipated revision was recommended but not performed. Conclusion: The 2-4 year results of ASC in maturing and mature patients with AIS demonstrated average curve correction of 65.5% in thoracic and 66.7% in lumbar curves. Clinical success with residual curves ≤ 30° was achieved in 47/49 (96%) of all thoracic curves and 31/33 (94%) of all lumbar curves. Average 3D thoracic kyphosis corrected from 2° pre to 34° post.

Treatment of Patients with Scoliosis Using a Unique Anterior Scoliosis Correction Technique

Treatment for adolescent idiopathic scoliosis (AIS) is dependent upon multiple factors, including curve type and magnitude, curve progression, skeletal maturity, and clinical trunk deformity. While fusion is effective at achieving curve correction, it is associated with disadvantages including prominent implants beneath the skin, back muscle scarring and atrophy, decreased spine range of motion, and decreased functional spinal mobility. Additional concerns include the potential for longer term development of premature adjacent level disc and facet joint degeneration above and below the fusion. Due to these issues with spinal fusion, surgeons have explored alternative surgical approaches to correct spinal deformity and halt curve progression using either growth modulation or remodeling of the spine while preserving motion. This paper provides an overview of a non-fusion scoliosis correction technique called Anterior Scoliosis Correction (ASC).

Feasibility of Single-Staged Bilateral Anterior Scoliosis Correction in Growing Patients.

Study Design:Retrospective analysis.Objectives:The objective of this study was to analyze the feasibility of correcting double-curve scoliosis using dynamic scoliosis correction (DSC, also known as vertebral body tethering), which requires a bilateral anterior approach with deflation of both lungs. Typically, this approach falls under the exclusionary criteria for the eligibility for anterior scoliosis surgery. No data exists on the feasibility of single-staged bilateral DSC.Methods:A retrospective analysis was performed utilizing the data from 25 patients who underwent a bilateral anterior thoracic approach and instrumentation. Thirty-day postoperative complication rates were analyzed. A learning curve subanalysis was also performed to compare the first 12 patients to the remainder of the 13 patients, with a T-test (P ≤ .05).Results:Of the 25 patients treated, there was 1 intraoperative event: After performing lumbar DSC, the contralateral DSC was abandoned due to unexpected pleural scarring and staged selective thoracic fusion was performed. We observed 4 postoperative complications: 2 patients had recurrent pleural effusions, 1 patient was diagnosed with pneumonia, and 1 patient had a minor pulmonary embolism without cardiopulmonary consequences (after an international 24 hour flight). All patients recovered well. We observed a significant influence of learning curve on surgical time (328 vs 280 min, P = .03) and blood loss (480 vs 197 mL, P = .03).Conclusion:Data suggests that bilateral, single-stage surgery for DSC is feasible albeit with an elevated complication rate that may partially attributable to the learning curve. Future research should focus on the cause of pulmonary complications and include a matched comparative analysis with traditional posterior fusion.

Alternatives to spinal fusion surgery in pediatric deformity

The standard of care for skeletally immature patients with idiopathic scoliosis is bracing for moderate curves. The standard of care for both skeletally immature and mature patients who have more severe or progressive curves is spinal fusion. We present a summary of four currently used non-fusion surgical techniques as alternatives to bracing and spinal fusion. Vertebral body stapling (VBS) is suggested for patients between the ages of 8 and 13 yr for girls and younger than 15 yr for boys with at least one year of growth remaining (Risser 0-1, Sanders digital stage ≤4). Thoracic curves should measure 25-35 degrees and lumbar curves 25-45 degrees. For best results, the curves should be flexible, bending to &lt; 20 degrees. Correction with a cord/screw construct includes vertebral body tethering (VBT) and anterior scoliosis correction (ASC), which are most commonly being performed for skeletally immature patients (Risser 0-2, Sanders digital stage ≤4) with thoracic and lumbar curves between 30-70 degrees that bend to &lt; 30 degrees. The authors of this article have expanded the indications for treating adolescents with idiopathic scoliosis who are more mature (Risser &gt; 2) with ASC. One commercial product has received CE mark approval in Europe for ASC treatment in both skeletally immature and mature patients. A second product utilizing posterior dynamic concave distraction, also with CE mark approval in Europe, is indicated for patients who are 10-17 yr old with primary single main thoracic or thoracolumbar curves between 30-60 degrees that correct to ≤35 degrees on bending films.

Intra-operative measurement of applied forces during anterior scoliosis correction

BackgroundSpinal instrumentation and fusion for the treatment of scoliosis is primarily a mechanical intervention to correct the deformity and halt further progression. While implant-related complications remain a concern, little is known about the magnitudes of the forces applied to the spine during surgery, which may affect post-surgical outcomes. In this study, the compressive forces applied to each spinal segment during anterior instrumentation were measured in a series of patients with Adolescent Idiopathic Scoliosis. MethodsA force transducer was designed and retrofit to a routinely used surgical tool, and compressive forces applied to each segment during surgery were measured for 15 scoliosis patients. Cobb angle correction achieved by each force was measured on intra-operative fluoroscope images. Relative changes in orientation of the screw within the vertebra were also measured to detect intra-operative screw plough. FindingsIntra-operative forces were measured for a total of 95 spinal segments. The mean applied compressive force was 540N (SD 230N, range 88N–1019N). There was a clear trend for higher forces to be applied at segments toward the apex of the scoliosis. Fluoroscopic evidence of screw plough was detected at 10 segments (10.5%). InterpretationThe magnitude of forces applied during anterior scoliosis correction vary over a broad range. These forces do reach magnitudes capable of causing intra-operative vertebral body screw plough. Surgeons should be aware there is a risk for tissue overload during correction, however the clinical implications of intra-operative screw plough remain unclear. The dataset presented here is valuable for providing realistic input parameters for in silico surgical simulations.