Comparative intermediate and long-term results of pedicle screw and hook instrumentation in posterior correction and fusion of idiopathic thoracic scoliosis.
METHODS
Prospective cohort study.


OBJECTIVE
To comprehensively compare the intermediate and long-term results of posterior correction and fusion with segmental pedicle screw instrumentation versus those with hook constructs in idiopathic adolescent thoracic scoliosis.


BACKGROUND
Posterior correction and fusion represent the current standard surgical treatment in progressive idiopathic thoracic scoliosis. The 3-column fixation of pedicle screws has been shown to be superior to all other posterior spinal fixation devices.


METHODS
A total of 168 patients with idiopathic thoracic scoliosis at a single institution who underwent a posterior spinal fusion with segmental pedicle screw (88) or a combination of hooks and pedicle screws (80) instrumentation. Patient's evaluation consisted of clinical and radiographic analysis preoperatively, postoperatively, and at final follow-up.


RESULTS
All patients were prospectively evaluated with an average follow-up of 5 years (range 5 to 11 y). The average number of segments in the fusion was 9.1 (range 6 to 15) in the hook group and 8.5 in the screw group (range 5 to 12). At the final follow-up, the amount of loss of correction in thoracic curves averaged 8.4 in the hook group and 5.3 in the screw group. The difference between the mean postoperative Cobb angle and the final Cobb angle of the major curves with a preoperative value was statistically significant in the 2 groups (P<0.01). The frontal and sagittal plane correction can be satisfactorily obtained by the screw group versus the pedicle screw group. There were no cases of pseudarthrosis, deep wound infections, or any neurologic complications.


CONCLUSIONS
Satisfactory correction and maintenance of scoliotic curves could be obtained by pedicle screw instrumentation compared with hook constructs. Thoracic and thoracolumbar pedicle screw instrumentation is a safe and reliable method for obtaining rigid segmental spinal fixation over the conventional hook and rod.
Wu
Xinghuo
X
Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Yang
Shuhua
S
Xu
Weihua
W
Yang
Cao
C
Ye
Shunan
S
Liu
Xianzhe
X
Li
Jin
J
Wang
Jing
J
D000293:Adolescent; D001863:Bone Screws; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D016268:Internal Fixators; D008297:Male; D018579:Patient Selection; D011446:Prospective Studies; D011859:Radiography; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation* / Q000379:methods; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome