Direct vertebral rotation and differently shaped dual rod translation technique in adolescent idiopathic scoliosis.

Direct vertebral rotation (DVR) is widely used to correct the axial deformity in adolescent idiopathic scoliosis (AIS). Indirect rotation techniques may help DVR in order to improve outcome. Vertebral translation technique combined with the use of two differently shaped rods resulted effective in reducing the rib hump deformity. The aim of this study is to describe the technique and evaluate the efficacy of combined DVR and vertebral translation technique on axial deformity correction. Mean follow-up was 2.7 years. Cobb angle, kyphosis angle, apical vertebrae axial rotation angle, SRS-22 questionnaire of 30 AIS patients treated with combined DVR and differently shaped dual rods translation technique were collected and compared preoperatively and postoperatively. At the last follow-up no screw pull-out, nonunion or loss of correction were recorded. The combination of DVR and differently shaped dual rods translation technique in AIS can provide good three-dimensional correction and improvement of patient's quality of life.

Simultaneous double rod and en-bloc direct vertebral rotation technique for correction of main thoracic adolescent idiopathic scoliosis: retrospective analysis of 14 cases.

Adolescent idiopathic scoliosis (AIS) is a triplanar deformity associated with rib hump, especially when a principle thoracic curve is present. The aim of this study is to evaluate the results of AIS correction retrospectively, using simultaneous double rod derotation manoeuvre technique followed by en-bloc direct vertebral rotation (DVR). Fourteen patients were included in this study. Coronal and sagittal thoracic Cobb angle, global coronal balance, sagittal balance, rib hump prominence, Scoliosis Research Society outcome instrument score (SRS-22) and Walter Reed visual assessment scale (WR-VAS) values were recorded pre- and postoperatively and evaluated. Results were evaluated at a mean follow-up of 2 years. Good to excellent radiographic and clinical results were obtained in all patients. No major perioperative complications occurred. This technique has proved to be effective for surgical correction of the deformity in Lenke type 1 AIS with good clinical and radiological results and low rate of complications.

Less invasive surgery in idiopathic scoliosis: a case report.

BACKGROUND: Minimally invasive spine surgery (MISS) has become popular during the last decade due to continuous evidence in favor of lesser soft tissue damage, faster recovery, higher patient satisfaction and reduced health costs. During the last years, surgical ambition for better results as well as most detailed knowledge of spinal anatomy, have resulted in the continuous and successful expansion of indications of MISS, covering already successfully a wide range of degenerative spinal pathologies as well as adult spinal deformities. AIM: We describe here a case report of a patient with adolescent idiopathic scoliosis (AIS) treated by minimally invasive posterior pedicle screw instrumentation. MATERIALS AND METHODS: We report the case of an 18 years old female patient affected by AIS, Lenke type 1AN, with a 65 degree right thoracic curve and severe rib hump. Posterior pedicle screw instrumentation as well as corrective manoeuvres were performed exclusively by minimally invasive procedure, through three small midline skin incisions. RESULTS: We obtained a good clinical and radiographical correction of scoliosis, which was maintained during the follow-up period. We also observed a limited intra-operative blood loss, a limited operative time, limited pain, earlier mobilization and limited hospital stay. CONCLUSIONS: A minimally invasive technique can be used for the surgical treatment of AIS, showing satisfying deformity correction and multiple perceived advantages, although long-term data are needed before this kind of surgery can be recommended for routine use.

Surgical treatment of neuromuscular scoliosis: current techniques.

41 consecutive patients surgically treated at Our Department by posterior only instrumented fusion from January 1995 to January 2009 were reviewed. There were 20 females and 21 males with a mean age of 15.8 years (range, 10 to 38). Diagnosis was: cerebral palsy (13 cases), Duchenne muscular dystrophy (7), spinal amyotrophy (7), myelomeningocele (5), poliomyelitis (3), Friedreich's ataxia (2), Escobar syndrome (2), Steinert's disease (1), Charcot Marie Tooth disease (1). Main scoliosis Cobb angle averaged 94.05° (range, 34° to 165°), the curve was thoracic in 19 cases, thoracolumbar or lumbar in 22 cases. Kyphosis (T5-T12) averaged 42.86° (range, 7° to 90°), lordosis was 33.57°. The fusion was extended to the lumbar tract in 23 patients, to the sacrum in the other 18. Our results showed that, in patients with neuromuscular scoliosis, posterior instrumented fusion is a safe and effective procedure and is the treatment of choice for patients with limited respiratory function, as in Duchenne muscular dystrophy and spinal muscular atrophy. The surgery should be performed as early as possible, and the extension of the fusion to the sacrum should be avoided in patients with residual walking ability.

Surgical treatment for scoliosis associated with rare disease.

This is a retrospective study of 11 patients, 7 females and 4 males, treated at Our Department for an early onset scoliosis (EOS) associated with rare syndromes with growing spinal implants (Growing Rod or VEPTR-like) from 2006 to 2011. Mean follow-up was 24 months (range, 12 to 36). The mean age at surgery was 7. Patients were affected by Escobar's syndrome (1), scoliosis associated to congenital heart disease (1), Arnold Chiari type 1 (1), syringomyelia (1), NF 1 (2), Prader-Willi syndrome (1), trisomy 8 (1), arthrogryposis (2) and spondylo-rib dysplasia (1). Each patient was studied from the genetic point of view, and were performed: brain-spine MRI, pulmonary function tests, Cardio-US and abdominal US, neuropsychiatric and neurological evaluation, C0-C2 CT scan. After first implant and lengthening procedures (11), the correction of the thoracic curve averaged 50%. Unfortunately, a little loss of correction of the lumbar curve occurred during the follow up. There were 8 post-operative complications, that required revision surgery in 2 cases. Our results confirmed the effectiveness and safety of growing spinal implants in the treatment of early-onset scoliosis in rare syndromes.

Complications incidence in the treatment of early onset scoliosis with growing spinal implants.

Early onset scoliosis (EOS) surgery based on growing spinal implants can lead to several complications. Aim of the study was to identify strategies to prevent those complications. A retrospective review was conducted to identify all pediatric patients affected by EOS surgically treated with growing rod or Vertical Expandable Prosthetic Titanium Rib (VEPTR) at our division between 2006 and 2011. Nineteen consecutive patients (8 males, 11 females; mean age 6.8 years) were included. The scoliosis was: idiopathic in 7 cases, congenital in 5, associated with congenital heart disease in 2, with syringomyelia and Arnold Chiari syndrome in 1, with neurofibromatosis type 1 (NF1) in 1, with Prader Willi syndrome in 1, with trisomy 8 in 1, with arthrogryposis in 1. Instrumentation used was: growing rod in 9 patients (dual rod construct in 8 cases, single rod in 1), VEPTR in 10 (always rib to spine construct). At a mean follow-up of 28 months (range, 12 to 55) 12 mechanical complications occurred in 8 of 19 patients treated (42.1%). Among cases treated with growing rod (9) 6 complications occurred in 4 patients (44.4%): revision was performed in 4 cases due to proximal anchors migration, in 2 cases due to a rod breakage. Among cases treated with VEPTR (10) 6 complications occurred in 4 patients (40%): revision was performed in 4 cases due to rib fracture with anchors migration, in 1 case due to vertebral anchor migration and in 1 case due to proximal and distal anchor migration. So, in our series mechanical complications rate was 42.1%. Our strategy to prevent these complications is to use hooks as proximal anchors, to avoid single rod construct and to use a brace as external support until final surgery is performed. If it's possible, is better to substitute VEPTR with a dual Growing Rod implant when patient's age and anatomy permits this.

Fueling the debate: Are outcomes better after posterior lumbar interbody fusion (PLIF) or after posterolateral fusion (PLF) in adult patients with low-grade adult isthmic spondylolisthesis?

STUDY DESIGN: Retrospective cohort study. CLINICAL QUESTION: Do more adult patients affected by low grade isthmic spondylolisthesis have significant clinical and radiological improvement following posterior lumbar interbody fusion (PLIF) than those who receive posterolateral fusion (PLF)? METHODS: One hundred and fourteen patients affected by adult low grade isthmic spondylolisthesis, treated with posterior lumbar interbody fusion or posterolateral fusion, were reviewed. Clinical outcome was assessed by means of the questionnaires ODI, RMDQ and VAS. Radiographic evaluation included CT, MRI, and x-rays. The results were analyzed using the Student t-test. RESULTS: The two groups were similar with respect to demographic and surgical characteristics. At an average follow-up of 62.1 months, 71 patients were completely reviewed. Mean ODI, RMDQ and VAS scores didn't show statistically significant differences. Fusion rate was similar between the two groups (97% in PLIF group, 95% in PLF group). Major complications occurred in 5 of 71 patients reviewed (7%): one in the PLIF group (3.6%), four in the PLF group (9.3%). Pseudarthrosis occurred in one case in the PLIF group (3,6%) and in two cases in PLF group (4.6%). CONCLUSIONS: In our series, there does not appear to be a clear advantage of posterior lumbar interbody fusion (PLIF) over posterolateral fusion (PLF) in terms of clinical and radiological outcome for treatment of adult low grade isthmic spondylolisthesis.

Thoracoplasty in the surgical treatment of adolescent idiopathic scoliosis.

A consecutive series of 40 adolescents surgically treated between 1998-2001, by posterior spinal fusion and thoracoplasty were compared with a similar group of 40 adolescents treated in the same period by posterior only segmental fusion. Clinical and radiographic analysis was performed, including the SRS-30 questionnaire and Pulmonary Function Tests (PFT). Minimum five years follow-up was requested. No statistical differences were found between the two groups in PFT's both pre-operatively and at latest follow up. Our findings suggest that thoracoplasty did not adversely affected long-term PFT's in AIS patients treated by posterior spinal fusion alone.