Comparison of vertebral rotation corrected by different techniques and anchors in surgical treatment of adolescent thoracic idiopathic scoliosis.
METHODS
Evaluation of radiographs and computed tomography in patients undergoing different surgical interventions for adolescent idiopathic scoliosis (AIS).


OBJECTIVE
To compare the correction of vertebral rotation by different surgical techniques and/or anchors in the treatment of AIS.


BACKGROUND
The technique and the technology used in the surgical treatment of AIS continue to evolve; there is little information about the comparison of the vertebral rotation correction of thoracic scoliosis by different surgical techniques and/or anchors.


METHODS
A retrospective study was performed on 106 consecutive patients with AIS, who underwent selective thoracic fusion with different surgical techniques and/or anchors, including hooks, wires, and pedicle screws on the periapical concave side from a posterior approach and an anterior approach using screws. The selection criteria were as follows: younger than 20 years of age, thoracic scoliosis (Lenke type 1, 2, and 3), selected thoracic fusion, and a minimum 2-year follow-up period, whereas thoracic hyperkyphosis was excluded. The patients were classified into group A (anterior approach, n=27), group H (hooks, n=39), group S (screws, n=25), and group W (wires, n=15). The Cobb angle and apical vertebral rotation were evaluated by plain radiography and computed tomography, respectively, before and after surgery and after 2 years of follow-up.


RESULTS
All 4 groups were matched for age, sex, preoperative major curve, and curve flexibility. In all groups, the coronal Cobb angle was significantly improved after surgery, without any significant differences between the 4 groups. The Rotation Angle midline values in group A, group H, and group S were significantly improved after 2 years of follow-up (P<0.01), but not for group W. Rotation Angle sagittal was significantly improved after 2 years only in group A. Classification of each group into 2 subgroups according to the flexibility index (>0.5 and <0.5) provided Rotation Angle sagittal values that demonstrated significant improvement postoperatively (P<0.01) for group A and group S subgroups with a flexibility index >0.5.


CONCLUSIONS
Compared with the use of hooks and the wires, vertebral rotation in AIS is effectively corrected by either the anterior approach or posterior pedicle screw fixation, especially in patients with more flexible scoliosis (a flexibility index >0.5).
Department of Pediatric Orthopedics, Beijing Jishuitan Hospital, Beijing, China.
Gang
G
Fu
Noriaki
N
Kawakami
Manabu
M
Goto
Taichi
T
Tsuji
Tetsuya
T
Ohara
Shiro
S
Imagama
D000293:Adolescent; D001863:Bone Screws / Q000592:standards / Q000706:statistics & numerical data; D002648:Child; D005260:Female; D006801:Humans; D016268:Internal Fixators / Q000592:standards* / Q000706:statistics & numerical data; D008297:Male; D017063:Outcome Assessment, Health Care / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies; D012399:Rotation; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation* / Q000379:methods*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult