Track topics on Twitter Track topics that are important to you
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
The aim of surgical treatment of scoliosis is to obtain fusion of the spinal column, balanced in the coronal and sagittal planes. Great success has been attained with coronal correction; however, the ...
Differential rod contouring is used to achieve 3-dimensional correction in adolescent idiopathic scoliosis instrumentations. How vertebral rotation correction is correlated with the amount of differen...
Mutation analysis of a candidate disease gene in a cohort of patients with moderate to severe Adolescent idiopathic scoliosis (AIS).
Adolescent idiopathic scoliosis (AIS) is a structural, lateral curvature with rotation of the spine that develops around puberty. The influence of this spinal deformity on three-dimensional trunk move...
Early detection of progressive adolescent idiopathic scoliosis (AIS) was assessed based on 3D quantification of the deformity.
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 ...
Scoliosis specific exercises have been shown to improve curve progression but there have been few studies that compare the different exercise approaches in adolescent idiopathic scoliosis ...
The problem of choosing the supporting vertebra was the subject of several studies. They do not suggest as regards the techniques that are not currently used or with insufficient setback. ...
The purpose of this pilot study is to determine the presence, frequency, and severity of mental health disorders amongst adolescents undergoing spinal surgery for scoliosis.
Adolescent Idiopathic Scoliosis (AIS) can change the respiratory dynamics and performance of the inspiratory and expiratory muscles, affecting ventilatory capacity. This was a randomized, ...
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.
Arthritis Fibromyalgia Gout Lupus Rheumatic Rheumatology is the medical specialty concerned with the diagnosis and management of disease involving joints, tendons, muscles, ligaments and associated structures (Oxford Medical Diction...
Arthroplasty Joint Disorders Orthopedics Spinal Cord Disorders Orthopedics is the science or practice of correcting deformities caused by disease or damage to the bones and joints of the skeleton. This specialized branch of surgery may ...