Correction of thoracic adolescent idiopathic scoliosis with segmental hooks, rods, and Wisconsin wires posteriorly: It's bad and obsolete, correct?

Keith H. Bridwell, Darrell S. Hanson, John M. Rhee, Lawrence G. Lenke, Christine Baldus, Kathy Blanke

Research output: Contribution to journalArticlepeer-review

48 Scopus citations

Abstract

Study Design. Forty-four consecutive thoracic idiopathic adolescent curves surgically treated between 1995 and 1999 at one institution were analyzed. All were thoracic curves; there were no lumbar curves, double major curves, or triple major curves. Objectives. To study the clinical and radiographic results for these 44 patients. Summary of Background Data. There is currently ongoing discussion regarding the "best treatment" for right thoracic idiopathic scoliosis. Methods. Patients were administered preoperative and postoperative Scoliosis Research Society questionnaires. Radiographs were studied for coronal correction, sagittal correction, junctional deformities two segments above/two segments below, fusion status, loss of correction status, complications, and imbalance of curves above and below. Radiographic analysis was by two independent observers. All patients were treated with bilateral 5.5-mm CD Horizon (M-10) instrumentation. Corrective forces were translational and in situ contouring. An average of 10 hooks and 4 Wisconsin wires were used for an average of 14 fixation points per 11 segments. Follow-up was minimum 2 years to maximum 5 years, with an average of 3-year, 10-month follow-up. Results. All were out of bed on postoperative day 1; none was braced after surgery. The average preoperative thoracic curve was 56°; the average ultimate postoperative curve was 31° (P = 0.0001). In the sagittal plane T5-T12 averaged 22° preoperation and 20° postoperation. For the complete study group (n = 44), the Cobb measurement (P = 0.001) and apical vertebral translation of the lumbar curve (P = 0.001) below improved. For the false double major curve (n = 11) patterns, the unfused lumbar curve averaged preoperation 46° and postoperation 27° (P = 0.0001). There were no neurologic deficits, no wound infections, and no respiratory complications. In regards to the Scoliosis Research Society questionnaires, significant (P < 0.05) changes preoperative to ultimate postoperative were found for questions 3, 5, 11, and 14. Conclusion. "Satisfactory" results were obtained in 44 patients treated with this technique. The complication rate was low and the fusion rate was high. Posterior treatment as described above produces reasonable and dependable results.

Original languageEnglish
Pages (from-to)2059-2066
Number of pages8
JournalSpine
Volume27
Issue number18
DOIs
StatePublished - Sep 15 2002

Keywords

  • Posterior segmental spinal instrumentation
  • Posterior spinal fusion
  • Translational in situ contouring

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