Skip pedicle screw fixation combined with Ponte osteotomy for adolescent idiopathic scoliosis.

PURPOSE: This study aimed to determine whether Ponte osteotomy combined with skip pedicle screw fixation (SPSF) can improve the correction rate and restore thoracic kyphosis for patients with adolescent idiopathic scoliosis. METHODS: Surgical time, blood loss, preoperative Cobb angle of the main thoracic curve, flexibility, Cobb angle at 1 year after surgery, thoracic curve correction rate, and Cincinnati correction index (CCI) were determined for both the Ponte (n = 17) and non-Ponte (control; n = 21) groups. Furthermore, kyphotic angles at T5-T12 before and 1 year after the surgery were measured. RESULTS: The following measurements were obtained for the Ponte and control groups, respectively: surgical time, 236 ± 13 and 187 ± 9 min; blood loss, 1,141 ± 150 and 745 ± 120 g; preoperative Cobb angle of the main thoracic curve, 52.5° ± 10.4° and 51.5° ± 9.2°; flexibility, 31.7 ± 13.2 and 45.1 ± 12.3% (p = 0.003); thoracic curve correction rate, 62.0 ± 2.5 and 63.6 ± 2.5%; CCI, 2.2 ± 0.2 and 1.5 ± 0.1 (p = 0.003); preoperative kyphotic angle at T5-T12, 11.3° ± 11.2° and 13.0° ± 9.0°; and kyphotic angle at T5-T12 at 1 year after the surgery, 21.8° ± 1.7° and 24.2° ± 1.9°. CONCLUSION: Ponte osteotomy was combined with SPSF in case of rigid curve. CCI was significantly greater in the Ponte group. Postoperative thoracic kyphotic angles were identical in both groups.

Pedicle morphology using computed tomography-based navigation system in adolescent idiopathic scoliosis.

STUDY DESIGN/SETTING: Retrospective study. OBJECTIVE: The purpose of this study was to use multidimensional analysis with a computed tomography (CT)-based navigation system to measure the outer cortical diameter and the maximum screw trajectory length of the pedicle of the thoracic and lumbar regions of the spine in adolescent idiopathic scoliosis (AIS) patients. Another objective was to identify pedicles that require cautious insertion of screws. SUMMARY OF BACKGROUND DATA: Pedicle diameter in AIS patients was narrower on the concave side of the scoliotic curve. Many researchers have measured pedicle diameter and length of AIS patients by using standard CT or magnetic resonance imaging (MRI), but only few have used 3-dimensional imaging, especially CT-based navigation. METHODS: Fifteen patients with right-side thoracic AIS who underwent pedicle screw fixation were studied. A CT-based navigation system was used to measure the pedicle diameter, defined as the widest outer cortical diameter at the narrowest part of the pedicle. Moreover, the maximum pedicle screw trajectory length was measured as the distance between the posterior cortical entry point of the pedicle screw and the anterior vertebral cortex in line with the axis of the pedicle between T1 and L5. In addition, the values of each parameter taken using the CT navigation system and the standard axial CT were compared. RESULTS: Pedicles on the concave side of the main thoracic curve apex and proximal thoracic curve tended to have the narrowest diameters. The mean length of the longest screw that could be fixed was longer on the right side, except for T8 and T9. Our data showed screw size feasibility as follows: 25 or 30 mm screws were feasible from T1 to T5; 30 or 35 mm screws, from T6 to T12; and 35 or 40 mm screws, from L1 to L5. Pedicle diameter measured by the CT navigation system was larger than that measured by standard axial CT. Left-side pedicle length measured by the CT navigation system was lesser than that measured by standard axial CT. CONCLUSIONS: Pedicle diameter in patients with AIS is narrower on the concave side of the scoliotic curve, and therefore, caution should be exercised during screw insertion on the concave side.