Correction of thoracic adolescent idiopathic scoliosis with segmental hooks, rods, and Wisconsin wires posteriorly: it's bad and obsolete, correct?
METHODS
Forty-four consecutive thoracic idiopathic adolescent curves surgically treated between 1995 and 1999 at one institution were analyzed. All were thoracic curves; there were no lumbar curves, double major curves, or triple major curves.


OBJECTIVE
To study the clinical and radiographic results for these 44 patients.


BACKGROUND
There is currently ongoing discussion regarding the "best treatment" for right thoracic idiopathic scoliosis.


METHODS
Patients were administered preoperative and postoperative Scoliosis Research Society questionnaires. Radiographs were studied for coronal correction, sagittal correction, junctional deformities two segments above/two segments below, fusion status, loss of correction status, complications, and imbalance of curves above and below. Radiographic analysis was by two independent observers. All patients were treated with bilateral 5.5-mm CD Horizon (M-10) instrumentation. Corrective forces were translational and in situ contouring. An average of 10 hooks and 4 Wisconsin wires were used for an average of 14 fixation points per 11 segments. Follow-up was minimum 2 years to maximum 5 years, with an average of 3-year, 10-month follow-up.


RESULTS
All were out of bed on postoperative day 1; none was braced after surgery. The average preoperative thoracic curve was 56 degrees; the average ultimate postoperative curve was 31 degrees (P = 0.0001). In the sagittal plane T5-T12 averaged 22 degrees preoperation and 20 degrees postoperation. For the complete study group (n = 44), the Cobb measurement (P = 0.001) and apical vertebral translation of the lumbar curve (P = 0.001) below improved. For the false double major curve (n = 11) patterns, the unfused lumbar curve averaged preoperation 46 degrees and postoperation 27 degrees (P = 0.0001). There were no neurologic deficits, no wound infections, and no respiratory complications. In regards to the Scoliosis Research Society questionnaires, significant (P < 0.05) changes preoperative to ultimate postoperative were found for questions 3, 5, 11, and 14.


CONCLUSIONS
"Satisfactory" results were obtained in 44 patients treated with this technique. The complication rate was low and the fusion rate was high. Posterior treatment as described above produces reasonable and dependable results.
Bridwell
Keith H
KH
Orthopaedic Surgery Department, Washington University School of Medicine, St. Louis, MO 63110, USA. bridwellk@msnotes.wustl.edu
Hanson
Darrell S
DS
Rhee
John M
JM
Lenke
Lawrence G
LG
Baldus
Christine
C
Blanke
Kathy
K
D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009984:Orthopedic Fixation Devices / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011859:Radiography; D012086:Reoperation; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D011795:Surveys and Questionnaires; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome