The use of short and rigid anterior instrumentation in the treatment of idiopathic thoracolumbar scoliosis: a retrospective review of 24 cases.
METHODS
The results of short anterior rigid rod instrumentation used to treat thoracolumbar scoliosis in 24 patients were reviewed retrospectively.


OBJECTIVE
To assess the safety and efficiency of anterior correction of thoracolumbar scoliosis using a single rigid rod with segmental fixation.


BACKGROUND
This method of treatment results from the historical difficulties noted in obtaining adequate correction in both planes for this particular type of curve while saving as many segments as possible. This approach seems to combine the advantages and avoid the limitations of posterior segmental and previous anterior segmental techniques.


METHODS
For this study, 24 patients with thoracolumbar scoliosis underwent anterior spinal correction and fusion using a single rigid rod and segmental fixation. Additionally, in five patients, this construct was supplemented by interbody titanium cages. The patients were assessed for the amount of correction obtained in the main curve, and for the spontaneous correction of the compensatory curves above and below. Trunk balance was measured on standing radiographs. The average age of the patients was 17.3 years (range, 10-43 years), and the average follow-up period was 3.6 years (range, 2-4.5 years).


RESULTS
Correction of the major curve at follow-up assessment was 54%, with a 73% correction of the instrumented area. The upper compensatory curve showed a 21% correction, and the lower curve a 59% correction. Over the duration of the follow-up period, the instrumented area showed kyphosis progression of 6.5 degrees. The five patients who had insertion of Harms cages tended to have a lower rate of correction. The average number of intervertebral mobile segments fused was 2.9 (range, 2-5 segments). No intraoperative complication occurred in relation to the anterior approach. A temporary sympathectomy effect on the side of the approach was noted in most patients. Two radiologic pseudarthrosis and one loss of fixation at the top of the construct were observed.


CONCLUSIONS
Anterior correction and fusion using solid rod instrumentation constitute effective and safe treatment of thoracolumbar scoliosis. As compared with posterior systems, it provides correction and rebalance of the trunk through a shorter fusion segment.
Spine Institute, Beth Israel Medical Center, New York, New York 10003, USA. fbitan@bethisraelny.org
Fabien D
FD
Bitan
Michael G
MG
Neuwirth
Paul L
PL
Kuflik
Andrew
A
Casden
Norman
N
Bloom
Sid
S
Siddiqui
D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008159:Lumbar Vertebrae / Q000002:abnormalities / Q000601:surgery*; D008297:Male; D012189:Retrospective Studies; D012600:Scoliosis / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation* / Q000379:methods; D013904:Thoracic Vertebrae / Q000002:abnormalities / Q000601:surgery*; D016896:Treatment Outcome