Implant-Related Complications Do Not Interfere with Corrections with the Shilla Technique in Early Onset Scoliosis: Preliminary Results.

Growth-preservation techniques are utilized in early onset scoliosis (EOS) cases requiring surgical intervention. The Shilla technique corrects the deformity by reducing additional surgeries with its growth-guidance effect. As with other techniques, various problems can be encountered following the administration of the Shilla technique. The aim of this study was to examine the effect of complications encountered with the Shilla treatment on correction and growth. Sixteen patients with a follow-up period of at least one year after receiving Shilla growth guidance for EOS were included in this retrospective study. No complications occurred, and no unplanned surgery was required in 50% of the cases. Of the remaining eight patients with postoperative implant-related complications (50%), six (37.5%) required unplanned surgery; this consequently caused implant failure in the proximal region in five cases (31.25%) and deep tissue infection around the implant in one case (6.25%). Deformity correction, spine length, and quality-of-life scores significantly improved in EOS through Shilla growth guidance. In terms of spinal growth and deformity correction, there were no significant differences between patients with implant-related problems and individuals without occurrences. Although implant-related problems were detected in our dataset and corresponding unexpected surgeries were necessary, these complications had no significant unfavorable influence on correction and spine growth.

Is It Necessary to Evaluate the Craniocervical Junction with Computed Tomoghraphy in Adolescent Spinal Deformities?

AIM: To assess the craniocervical junction (CCJ) by using radiological measurements in patients with adolescent idiopathic scoliosis (AIS) and Scheuermann?s kyphosis (SK), and to compare those reults with healthy adolescent population. MATERIAL AND METHODS: Patients were assigned to three groups. Group 1 consisted of AIS patients, Group 2 consisted of patients with SK, and Group 3 was the control group who did not have any spinal disorder. The groups were matched based on age and gender. Major Cobb angle and kyphosis angle were measured on X-Ray. asion-axial interval (BAI), basion-dens interval (BDI), posterior atlantodental interval (PADI), anterior atlantodental interval (ADI), atlanto-occipital interval (AOI), and Power?s ratio were measured by computerized tomography. The results were compared in each group statistically. RESULTS: A total of 120 participants, comprised of 78 (65%) female and 42 (35%) male were included in the study. There was no statistically difference between 3 groups based on age and gender (p > 0.05). According to the measurements, Group 3 had significantly higher PADI measurements than Group 1 (p=0.01). The ADI measurements of Group 2 were significantly higher than those of Group 1 and Group 3 (p=0.01). Group 3 had significantly higher BDI measurements than Group 1 and Group 2. (p=0.01). The Power ratios of Group 1 and Group 3 were statistically higher than that of Group 2 (p=0.01). There were no statistically significant differences between the groups in terms of AOI and BAI measurements (p=0.84, p=0.18, respectively). CONCLUSION: The presence of AIS and SK may affect the measurement of CCJ, and it may be considered to evaluate instability of the region.

Is the Measurement of Pedicle Axial Axes on Computed Tomography in Adolescent Idiopathic Scoliosis Also a Guide for Safer Screwing?

OBJECTIVE: To evaluate the effect of pedicle angle measurement in preoperative axial computed tomography in patients with adolescent idiopathic scoliosis (AIS) on correct thoracic screw placement in free-hand technique on 3-dimensional printing AIS models. METHODS: In this study, 14 3-dimensional spine models with a scale of 1:1, including the entire spine of a patient with Lenke type 1 curve, were used. Group 1 included screwing applications with unknown pedicle axial angles, and group 2 included screwing applications with known pedicle axial angles. The number and direction of screws in malposition were recorded. In addition, medial encroachment distances of the screws were classified as 0-4 mm and greater than 4 mm, and lateral encroachment distances were classified as 0-6 mm and greater than 6 mm. Evaluation parameters were compared statistically between the groups. RESULTS: The number of screws in the correct position in group 1 was lower than that in group 2 (P < 0.05). The medial and lateral malposition rate in group 1 was greater than that in group 2 (P < 0.05). The medial encroachment rate of 4 mm and greater and lateral encroachment rate of 6 mm and greater in group 1 was greater than that in group 2 (P < 0.05). The medial encroachment rate of 0-4 mm and lateral encroachment rate of 0-6 mm were similar between groups 1 and 2 (P > 0.05). CONCLUSIONS: Measurement of pedicle axial axes of preoperative thoracic vertebrae on computed tomography in patients with AIS offers more reliable screwing in free-hand technique.