Apical Vertebral Rotation in Adolescent Idiopathic Scoliosis: Comparison of Uniplanar and Polyaxial Pedicle Screws.
Summary of "Apical Vertebral Rotation in Adolescent Idiopathic Scoliosis: Comparison of Uniplanar and Polyaxial Pedicle Screws."
Retrospective radiographic outcome analysis.
To compare residual postoperative apical vertebral rotation between uniplanar versus polyaxial bilateral pedicle screw constructs in thoracic adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND
Vertebral rotation is a component of the 3-dimensional deformity of AIS. The correction of vertebral rotation is an important goal of surgery. A comparison of uniplanar versus polyaxial screws has yet to be studied.
A review of a multicenter database of Lenke type 1 to 3 AIS patients who underwent surgical correction of thoracic AIS by posterior segmental pedicle screw instrumentation and fusion with either uniplanar or polyaxial pedicle screws and 5.5-mm steel rod constructs was performed. Curves greater than 100 degrees were excluded to control for the propensity to use polyaxial screws to correct larger curves. Postoperative apical vertebral rotation of thoracic curves was graded as 0, 1, or 2 based on a computed tomography scan-validated radiographic method that uses the relative position of the screw tips to grade apical vertebral rotation at the 6-week and 1-year postoperative visits. By this grading method, higher grades correspond to greater residual apical vertebral rotation.
Two hundred and ten patients met the inclusion criteria. The uniplanar screw group included 95 patients whereas the polyaxial screw group had 115 patients. The respective mean preoperative thoracic Cobb angle of 58±12 and 60±13 degrees (P=0.1), first erect postoperative coronal correction of 72% and 74% (P=0.38), and 1-year correction of 70% and 76% (P=0.07) were not significantly different between the uniplanar and polyaxial groups. At 6 weeks postoperation, the uniplanar group had 34% of patients with grade 0 rotation, 52% with grade 1, and only 14% with grade 2 thoracic apical vertebral rotation. In the polyaxial group, only 14% of patients were grade 0, 35% were grade 1, and 51% were the most rotated grade 2. This was a significant difference in the distribution of the axial rotation grades (P<0.001), with less residual apical vertebral rotation with the use of uniplanar screws. The same pattern of results was found at 1-year postoperative evaluation (P<0.001).
There was little difference in the coronal plane correction of thoracic curves between the 2 types of screws. However, the uniplanar pedicle screw group had a larger proportion of patients with greater thoracic apical vertebral derotation (less residual apical vertebral rotation) compared with the polyaxial screw group. This can be attributed to the increase in rotational leverage afforded by uniplanar screws during intraoperative bilateral direct apical vertebral derotation maneuvers.
*Department of Orthopaedic Surgery, University of Illinois, Chicago, IL †Department of Orthopedic Surgery, University of California San Diego ‡Department of Orthopedic Surgery, Rady Children's Hospital and Health Center, San Diego, CA §Department of
This article was published in the following journal.
Name: Journal of spinal disorders & techniques
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/20844450
- DOI: http://dx.doi.org/10.1097/BSD.0b013e3181edebc4
Curve flexibility in adolescent idiopathic scoliosis (AIS) was one of the major concerns of spinal surgeons since the evolution of surgical correction techniques. In this respect, many tried to identi...
Numerous indirect methods for apical vertebral rotation (AVR) measurement have been reported and none of them seems to be as accurate as computed tomography evaluation. The aim of this study was to co...
Adolescent idiopathic scoliosis is the most common type of spinal deformity whose aetiology remains unclear. Studies suggest that gravitational forces in the standing position play an important role i...
Nonstructural curves are defined in the Lenke classification system for adolescent idiopathic scoliosis as bending out to
A genetic association study of 53 single nucleotide polymorphisms (SNPs) with adolescent idiopathic scoliosis (AIS).
The purpose of this study is to find out the outcomes of using the PASS LP System to correct adolescent idiopathic scoliosis. This system is a unique set of spinal instrumentation used to ...
Adolescent Idiopathic Scoliosis (AIS) can change the respiratory dynamics and performance of the inspiratory and expiratory muscles, affecting ventilatory capacity. This was a randomized, ...
Adolescent idiopathic scoliosis (AIS) is a structural curve of the spine with no clear underlying cause. Bracing is currently the standard of care for preventing curve progression and trea...
The purpose of this study is to determine whether Calcium and Vit D supplementation is effective for improving low bone mass in Girls with Adolescent Idiopathic Scoliosis (AIS).
Adolescent Idiopathic scoliosis affects 3-4% of the Canadian population, of which about 10% will need a brace treatment during pubertal growth spurt. The design is made relatively corsets ...
Medical and Biotech [MESH] Definitions
Deformities of the SPINE characterized by abnormal bending or flexure in the vertebral column. They may be bending forward (KYPHOSIS), backward (LORDOSIS), or sideway (SCOLIOSIS).
Comparison of various psychological, sociological, or cultural factors in order to assess the similarities or diversities occurring in two or more different cultures or societies.
The rotation of linearly polarized light as it passes through various media.
Any observable response or action of an adolescent.
An adolescent who is receiving long-term in-patient services or who resides in an institutional setting.