title: Comparison of radiographic outcomes for the treatment of scoliotic curves greater than 100 degrees: wires versus hooks versus screws.
abstract: METHODS
  A retrospective comparative study.
  
  
  OBJECTIVE
  To compare the efficacy and safety of several different anchors in the apical levels of scoliotic curves > or = 100 degrees using radiographic outcomes and clinical complications.
  
  
  BACKGROUND
  To the best of our knowledge, no reports have compared various anchors at the apical level for correction of scoliosis curves > or = 100 degrees.
  
  
  METHODS
  Sixty-eight scoliosis patients (44 neuromuscular, 21 idiopathic, and 3 congenital) with major curves > or = 100 degrees (mean, 112.7 degrees; range, 100 degrees -159 degrees ) who underwent segmental spinal instrumentation and fusion with different anchors in the apical level were analyzed. All patients had a minimum 2-year follow-up (mean, 4.0 years; range, 2.0-10.5) and were divided into Group W (sublaminar wires n = 26), Group H (hooks n = 18), Group A (anterior vertebral screws n = 7), and Group PS (pedicle screws n = 17) based on the type of apical anchor used. Radiographic parameters and complications were investigated.
  
  
  RESULTS
  The 4 groups did not demonstrate any significant differences in gender, age at surgery, preoperative major Cobb angle, or curve flexibility (all P > 0.05). However, the PS group demonstrated a shorter follow-up period compared with the other 3 groups (P < 0.05). The PS group demonstrated the greatest correction rate, smallest loss of correction (P < 0.05), and greatest amount of correction of the apical vertebral translation (P < 0.0005) at ultimate follow-up. There were 4 cases (5.9%) of pseudarthrosis (3 in Group W, 1 in Group H; P > 0.05), 6 cases (8.8%) of implant failure (4 in Group W, 2 in Group H; P > 0.05). Despite one (1.5%) intraoperative neurologic complication (differences among groups, P > 0.05), there was no permanent neurologic deficit.
  
  
  CONCLUSIONS
  All 4 constructs were able to achieve and maintain acceptable correction safely without permanent neurologic deficit and all demonstrated acceptable implant failure rate. Pedicle screw constructs in the apical levels demonstrated the best coronal correction, smallest loss of correction, and greatest amount of apical vertebral translation correction of the major Cobb angle compared with the other constructs without neurologic complications.
authors.affiliation: Niigata University, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Watanabe
authors.forename: Lawrence G
authors.initials: LG
authors.lastname: Lenke
authors.forename: Keith H
authors.initials: KH
authors.lastname: Bridwell
authors.forename: Yongjung J
authors.initials: YJ
authors.lastname: Kim
authors.forename: Kota
authors.initials: K
authors.lastname: Watanabe
authors.forename: Young-Woo
authors.initials: YW
authors.lastname: Kim
authors.forename: Youngbae B
authors.initials: YB
authors.lastname: Kim
authors.forename: Marsha
authors.initials: M
authors.lastname: Hensley
authors.forename: Georgia
authors.initials: G
authors.lastname: Stobbs
mesh_terms: D000293:Adolescent; D000328:Adult; D001863:Bone Screws; D001864:Bone Wires; D002648:Child; D004868:Equipment Failure; D005260:Female; D006801:Humans; D008297:Male; D011859:Radiography; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012189:Retrospective Studies; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D012720:Severity of Illness Index; D013123:Spinal Fusion / Q000009:adverse effects / Q000295:instrumentation*; D013131:Spine / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D013525:Surgical Instruments; D016896:Treatment Outcome