Surgical Treatment Of Idiopathic Scoliosis Research Articles

Survivorship analysis of Cotrel-Dubousset instrumentation in idiopathic scoliosis.

This study presents a survivorship analysis of Cotrel-Dubousset instrumentation in the surgical treatment of idiopathic scoliosis. Between 1987 and 1995, a total of 133 patients with idiopathic scoliosis received posterior spine fusion and instrumentation with the CD system at our center. The patients' mean age at surgery was 16.5 years (range 11-43 years). The magnitude of the thoracic scoliosis averaged 62.7 degrees (range 40 degrees -125 degrees ) and that of the lumbar curve was 58.8 degrees (range 40 degrees -100 degrees ). On average, 12.2 segments were fused (range 8-17) and, excluding the rods, 14.1 implants were set for each patient (range 10-21). Survivorship analysis was carried out using the Kaplan-Meier method. Implant removal was considered the terminal event, or "death". The effect of several variables on survival rate was determined with the Cox regression method. The patients remained in the study for 56.7 months (range 2-120 months). One-hundred and ten patients were withdrawn ("censored"): 90 "alive" (did not require repeat surgery and attended follow-up control in 1997) and 20 "lost" (did not attend control in 1997). Twenty-three patients attained the terminal event of implant removal for a variety of reasons: acute infection (three cases), late infection (ten cases), implant failure requiring revision (six cases) and local pain (four cases). The survival rate was 95.5% at 3 months, 94.7% at 6 months, 93.9% at 1 year, 91.5% at 2 years, 82.2% at 5 years and 76.5% at 10 years. The magnitude of the curves, total number of implants and number of fused segments did not correlate with survival probability. A positive correlation was found between survival rate and correction loss between surgery and last control. A survival rate of 76.5% at 10 years is unexpectedly low. Current data suggest that the incapacity to maintain correction after initial surgery plays a major roll in the long-term evolution of Cotrel-Dubousset instrumentation.

Ｃｏｂｂ角４５°以上で治療終了した特発性側わん症非手術例の検討

The indication of surgical treatment for idiopathic scoliosis showing a Cobb angle of more than 45 degrees after skeletal maturity is controversial. We investigated the clinical course of 20 patients with idiopathic scoliosis who had been treated conservatively showing a Cobb angle of more than 45 degrees at the time of skeletal maturity. At the final follow-up, the Cobb angle had increased in 8 out of 20 patients. The Cobb angle had progressed in patients with single curve or severe rotation of the vertebrae even after skeletal maturity. A few patients complained of low back pain and cosmetic discontent. The progression of deformity should be observed in patients showing idiopathic scoliosis with single curve or severe rotation of the vertebrae even after skeletal maturity.

Surgical treatment of idiopathic scoliosis in adults: an age-related analysis of outcome.

A retrospective outcome study was conducted. To analyze the clinical and radiographic outcome of surgical treatment for idiopathic scoliosis in patients treated at the age of 20 years or older. Idiopathic scoliosis continues to pose problems in many patients after adolescence. Surgical treatment of idiopathic scoliosis in adults still is a challenging subject, but no outcome analysis in terms of different age groups had been performed. In this study, 58 adult patients with idiopathic scoliosis who underwent surgery using Cotrel-Dubousset instrumentation were followed up for 2 to 7 years, and the results were studied clinically and radiographically. The prevalence of pain that requires specific treatment decreased from 16% to 5%, and the pain improvement was reliably obtained in the older patients. Radiographically, the mean rate of Cobb angle correction was 53% for both the thoracic and lumbar curves, whereas it decreased age dependently, especially in relation to the thoracic curve. The sagittal plane correction generally was satisfactory in patients younger than 50 years, but appropriate lumbar lordosis was difficult to maintain after the age of 50 years. Frontal and sagittal balance often was difficult to achieve in patients older than 50 years. This study clarified specific characteristics and problems in the surgical treatment of adult idiopathic scoliosis according to different age groups. Although pain was the most important indication for surgery in patients older than 40 years, it was improved reliably by surgery in most of these patients. On the other hand, the radiographic results tended to be less satisfactory in the older patients in an age-dependent manner. These results provide useful information concerning the indications and strategies of adult scoliosis surgery.

Current surgical treatment of idiopathic scoliosis

Current surgical treatment of idiopathic scoliosis

Surgical treatment of idiopathic scoliosis and juvenile kyphosis

Indication for operative treatment of idiopathic scoliosis and juvenile kyphosis is mainly cosmetic. There is also a higher incidence of pain in scoliosis patients, and reduced pulmonary function in severe deformity, especially in severe deformities present at the age of 5 years (early onset). Scoliotic curves of less than 30 degrees will not progress in adults, whereas curves of 50-75 degrees will further progress a mean of 25 degrees during 40 years. Progression in adults with juvenile kyphosis is not well documented. Operative treatment aims to stop progression, to control spinal growth, or to perform correction and fusion by spinal instrumentation and bone grafts. These goals can be achieved either by an anterior, a posterior, or a combined approach. Correction principles are compression, distraction, derotation and translation. The forces applied by correction are transferred by fixation devices (pedicle screws, anterior screws, hooks, sublaminar wires) to the spine. The higher correction forces are, the higher is the correction achieved, but also the risk of fracture and torn out implants. Mobilisation reduces rigidity and allows to achieve a better correction with equal forces. The best mobilisation techniques are disc excision, facet joint removal, and techniques to mobilise the thorax.

Safety of sublaminar wires with Isola instrumentation for the treatment of idiopathic scoliosis.

To investigate the incidence of acute neurologic complications of use of sublaminar wires with third-generation spine instrumentation for the treatment of idiopathic scoliosis. To assess the safety of sublaminar wires in the surgical treatment of idiopathic scoliosis. The use of sublaminar wires in spine deformity for neuromuscular scoliosis and the Luque system has been reported. Use of sublaminar wires is an integral part of the technique in the surgical treatment of spine deformity with Isola instrumentation (AcroMed, Cleveland, OH). To date, the safety of this technique has not been documented. The average age of the patients was 37 years (range, 11-74 years). Preoperative diagnosis was adolescent idiopathic scoliosis in 75 patients and adult idiopathic scoliosis in 66. One hundred nine were primary surgeries, and 32 were revision. Detailed evaluation of the curve type, curve magnitude, number of vertebrae instrumented, level of vertebrae wired, postoperative neurologic deficit, and the findings of intraoperative spinal cord monitoring was performed. Wires were always passed just before corrective maneuvers were performed. A total of 1366 wires were placed, 65% (n = 888) in the thoracic region, 22% (n = 300) in the thoracolumbar, and 13% (n = 178) in the lumbar. No permanent change in intraoperative spinal cord monitoring was detected. Stagnara wake-up test was performed in all patients. No patient with adolescent idiopathic scoliosis had neurologic complication. Two adults underwent revision surgery and had transient dysesthesia in the leg, which completely resolved with observation. Despite the increasing complexity of spinal instrumentation systems, sublaminar wire placement is a safe and useful adjunct in the surgical treatment of neurologically intact patients with idiopathic scoliosis.

The Selection of Fusion Levels Using Torsional Correction Techniques in the Surgical Treatment of Idiopathic Scoliosis

This is a retrospective, consecutive case series, with the index patient included. To evaluate the evolution and effectiveness of instrumentation techniques designed to untwist the scoliosis deformity. Three-dimensional studies of the idiopathic scoliosis deformity are consistent with the theory that the deformity or deformities evolve as an imperfect torsion or torsions. From 1989 through 1995, 102 consecutive patients (84 females, 18 males) underwent surgery with increasing emphasis on torsional correction. One hundred patients (98%), with an average age of 14.3 years (range, 10.5-20.8 years), were observed for an average of 40 months (range, 24-81 months). The upper instrumented vertebra evolved to be the centered vertebra. The lower instrumented vertebra was chosen based on its ability to become horizontal on contralateral bend radiographs and was termed the caudal foundation vertebra. Because these techniques evolved over the first 3 years of the study period, a split analysis was performed to evaluate improvements in correction and correction maintenance over the course of the study. The average Cobb angle was 59 degrees before surgery, 18 degrees after surgery (69% correction), and 22 degrees (63% correction) at latest follow-up. A comparison of the first half of the series with the second half showed no significant demographic differences. Curve correction was significantly improved for King-Moe IIB (thoracolumbar-lumbar curve only), King-Moe III, and King-Moe V curve types in the second half of the series. In the last 4 years, curve correction at latest follow-up for King-Moe IIB curves was 61% for the thoracic curve and 65% for the thoracolumbar-lumbar curve. King-Moe III curves had a 68% correction, and King-Moe V curves had a 50% high thoracic and a 72% thoracic curve correction. Thoraco-lumbar, lumbar, and King-Moe I curves averaged 81% correction of the thoracolumbar-lumbar curve. The angle of thoracic curve inclination improvement at 1 year was maintained at latest follow-up. This method of selecting instrumentation levels while using torsional correction techniques is safe and reliable. The results were improved with the evolution of these techniques and appear to provide improved correction and correction maintenance compared with that of historical controls.

Is the Cotrel-Dubousset really universal in the surgical treatment of idiopathic scoliosis?

We reviewed the results of 22 cases of Cotrel-Dubousset (C-D) instrumentation, 16 cases of anterior approach, and 200 cases of posterior approach by Harrington instrumentation and modifications of Harrington procedure. Posterior spinal fusion and instrumentation by C-D gives better correction and stabilization in thoracic and balanced double major curves. We no longer use the Harrington procedure and its modification. In lumbar and short thoracolumbar curves, VDS is still preferred. In some double major curves combined procedures, VDS and C-D are used to obtain more correction with a shorter fusion area.

Results of surgical treatment of adults with idiopathic scoliosis.

The outcome of surgical treatment of idiopathic scoliosis in forty-five adults was studied with special attention to pain, function, self-image, and pulmonary function. All of the patients were more than twenty-five years old at operation and had been followed for more than three years. Every patient who was operated on by one of us (J. E. H.) and who met these criteria was evaluated. The magnitude of the curves averaged 66 degrees. Standardized gradations of pain and function showed improvement over-all, but significant impairment remained. There was a reduction in the levels of peak and constant pain, but no change in the frequency of peak pain after operation. The number of patients who were pain-free after surgery was not increased. Functional impairment due to the scoliosis was lessened, and the ability to perform the common activities of daily living was improved, but no important changes in occupation or recreational activity were recorded. Correlations of pain or function, or both, and the changes in either, were found with only two parameters: age at follow-up and physical occupation. Pulmonary function, as measured, did not change. Eighteen (40 per cent) of the patients had a minor complication and ten (20 per cent), a major complication; there was one death, due to pulmonary embolism, of a patient who was excluded from the series. In view of the high rate of complications, the limited gains to be derived from spinal fusion should be assessed and clearly explained to patients before the procedure is undertaken.

Pseudarthrosis following treatment of idiopathic scoliosis by Harrington instrumentation and fusion without added bone.

A retrospective review was conducted to assess the incidence of pseudarthrosis among 381 patients who had surgical treatment of idiopathic scoliosis by Harrington distraction rod and posterior fusion without added bone. In 260 patients where the lowest level of fusion was at or above the third lumbar vertebra, there were no cases of pseudarthrosis. In the remaining 121 patients with fusion extending below the third lumbar level, there were eight cases, an incidence of 6.6%, for an overall incidence of 2.5%.

The use of shortened periods of rigid postoperative immobilization in the surgical treatment of idiopathic scoliosis.

Seventy-eight consecutive patients with idiopathic scoliosis treated by Harrington instrumentation and spine fusion were allowed to walk shortly after operation, first in an underarm plaster cast for ten weeks and then in a canvas-front, hard-back Rohadur or Lexan brace until all external support was discontinued six months after operation. Sixty-four patients were followed for two years or more. Single thoracic curves, comprising almost half of the series, had an average final correction of 48 per cent, while all curves had an average final correction of 44 per cent. The average total loss of correction was 8 degrees, with approximately equal amounts lost in the first and second three months after operation. The incidence of pseudarthrosis was 1.5 per cent and the complications were minor. This series demonstrated that, for cooperative patients with idiopathic scoliosis of less than 90 degrees, the operative procedure and postoperative immobilization described can be expected to result in solid fusion without excessive loss of initial correction, pleasing cosmetic results, and less inconvenience to the patient because of decreased time in a plaster cast and early ambulation.

Early ambulation after the surgical treatment of idiopathic scoliosis: L. L. Leider, J. H. Moe, and R. B. Winter. J. Bone Joint Surg. 55A: 1003–1015: (July), 1973

Early ambulation after the surgical treatment of idiopathic scoliosis: L. L. Leider, J. H. Moe, and R. B. Winter. J. Bone Joint Surg. 55A: 1003–1015: (July), 1973

Early Ambulation after the Surgical Treatment of Idiopathic Scoliosis

From January 1968 through June 1970, 106 consecutive patients in the age range from twelve to twenty years had surgical treatment of their idiopathic scoliosis under the same management regimen. This consisted of careful articular-process fusion, usually in a preoperative cast, combined with Harrington instrumentation and addition of autogenous iliac-crest bone graft; careful application of a modified Risser-Cotrel cast and ambulation on an average of ten days following surgery; cast change at four to five months, and then removal of all support at an average of nine months following surgery. Follow-up averaged nineteen months. Correction obtained on the day of surgery compared with final correction standing out of plaster revealed an average loss of only 5 degrees. The pseudarthrosis rate was 4.7 per cent.

The Surgical Treatment of Idiopathic Scoliosis

*Professor and Chairman, Division of Orthopaedic Surgery, University of Rochester School of Medicine and Dentistry; Orthopaedic Surgeon-in- Chief, Strong Memorial Hospital, Rochester, New York. Present address: 260 Crittenden Boulevard, Rochester, New York 14642

Surgical treatment of idiopathic scoliosis

Surgical treatment of idiopathic scoliosis

Surgical treatment of idiopathic scoliosis.

Surgical treatment of idiopathic scoliosis.