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. 2014 Aug;8(4):345-52.
doi: 10.1007/s11832-014-0604-1. Epub 2014 Aug 2.

Morbidity and radiographic outcomes of severe scoliosis of 90° or more: a comparison of hybrid with total pedicle screw instrumentation

Ilkka Helenius  1 , Mikko Mattila, Tuomas Jalanko
Affiliations

Morbidity and radiographic outcomes of severe scoliosis of 90° or more: a comparison of hybrid with total pedicle screw instrumentation

Ilkka Helenius et al. J Child Orthop. 2014 Aug.

Abstract

Objectives: Untreated severe scoliosis is associated with increased mortality and remains a significant surgical challenge. Few studies have reported mortality after the surgical treatment of severe scoliosis beyond a 2-year follow-up. The objectives of this study were to evaluate mortality beyond standard 2-year follow-up and compare radiographic outcomes using hybrid or pedicle screw instrumentation for severe scoliosis.

Methods: We evaluated 32 consecutive patients [11 males, mean age at surgery 15.3 (range 10.7-20.7) years] operated for a scoliosis of 90° or more using either hybrid (n = 15) or pedicle screw (n = 17) instrumentation. The follow-up time averaged 2.9 (2.0-6.6) years for radiographic and quality of life measurements and 5.5 years (2.0-9.0) years for mortality data. Of these patients, one had adolescent idiopathic scoliosis, three secondary scoliosis, and 28 neuromuscular scoliosis. Twelve patients in the hybrid and two patients in the pedicle screw groups underwent anteroposterior surgery (p < 0.001), and three patients in both groups had an apical vertebral column resection.

Results: One (3.1 %) patient died during follow-up for severe pneumonia. Preoperatively, the mean magnitude of the major curve was 109° (90°-127°) in the hybrid and 100° (90°-116°) in the pedicle screw groups (p = 0.015), and was corrected to 45° (19°-69°) in the hybrid and 27° (18°-40°) in the pedicle screw groups at the 2-year follow-up (p < 0.001), with a mean correction of the major curve of 59 % (37-81 %) in the hybrid versus 73 % (60-81 %) in the pedicle screw groups, respectively (p = 0.0023). There were six postoperative complications, including one transient spinal cord deficit necessitating reoperation in the hybrid group as compared with five complications in the pedicle screw group (p = 0.53).

Conclusions: The mid-term mortality rate after the surgical treatment of severe scoliosis was low. Severe scoliosis can be treated safely with significantly better correction of the spinal deformity using pedicle screws than hybrid instrumentation.

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Figures

Fig. 1
Fig. 1
14-year-old boy with cerebral palsy (CP; spastic tetraparesis) and severe neuromuscular scoliosis. Anteroposterior spinal deformity correction with hybrid instrumentation provided excellent and stable correction at the 2-year follow-up
Fig. 2
Fig. 2
18-year-old girl with severe neuromuscular scoliosis. All posterior instrumentation using bilateral pedicle screws provided excellent correction and no loss of correction during the 2-year follow-up
See this image and copyright information in PMC

References

    1. Pehrsson K, Larsson S, Oden A, Nachemson A. Long-term follow-up of patients with untreated scoliosis. A study of mortality, causes of death, and symptoms. Spine (Phila Pa 1976) 1992;17:1091–1096. doi: 10.1097/00007632-199209000-00014. - DOI - PubMed
    1. Newton PO, Faro FD, Gollogly S, Betz RR, Lenke LG, Lowe TG. Results of preoperative pulmonary function testing of adolescents with idiopathic scoliosis. A study of six hundred and thirty-one patients. J Bone Joint Surg Am. 2005;87:1937–1946. doi: 10.2106/JBJS.D.02209. - DOI - PubMed
    1. Watanabe K, Lenke LG, Bridwell KH, Kim YJ, Watanabe K, Kim YW, Kim YB, Hensley M, Stobbs G. Comparison of radiographic outcomes for the treatment of scoliotic curves greater than 100 degrees: wires versus hooks versus screws. Spine (Phila Pa 1976) 2008;33:1084–1092. doi: 10.1097/BRS.0b013e31816f5f3a. - DOI - PubMed
    1. Kim YJ, Lenke LG, Bridwell KH, Kim KL, Steger-May K. Pulmonary function in adolescent idiopathic scoliosis relative to the surgical procedure. J Bone Joint Surg Am. 2005;87:1534–1541. doi: 10.2106/JBJS.C.00978. - DOI - PubMed
    1. Dobbs MB, Lenke LG, Kim YJ, Luhmann SJ, Bridwell KH. Anterior/posterior spinal instrumentation versus posterior instrumentation alone for the treatment of adolescent idiopathic scoliotic curves more than 90 degrees. Spine (Phila Pa 1976) 2006;31:2386–2391. doi: 10.1097/01.brs.0000238965.81013.c5. - DOI - PubMed

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