Posterior Surgery for Adolescent Idiopathic Scoliosis With Pedicle Screws and Ultrahigh-Molecular Weight Polyethylene Tape: Achieving the Ideal Thoracic Kyphosis.
Prospective clinical case series.



To describe our surgical procedure and results for posterior correction and fusion with a hybrid approach using pedicle screws, hooks, and ultrahigh-molecular weight polyethylene tape with direct vertebral rotation (DVR) (the PSTH-DVR procedure) for treatment of adolescent idiopathic scoliosis (AIS) with satisfactory correction in the coronal and sagittal planes.



Introduction of segmental pedicle screws in posterior surgery for AIS has facilitated good correction and fusion. However, procedures using only pedicle screws have risks during screw insertion, higher costs, and decreased postoperative thoracic kyphosis. We have obtained good outcomes compared with segmental pedicle screw fixation in surgery for AIS using a relatively simple operative procedure (PSTH-DVR) that uses fewer pedicle screws.



The subjects were 30 consecutive patients with AIS who underwent the PSTH-DVR procedure and were followed for a minimum of 2 years. Preoperative flexibility, preoperative and postoperative Cobb angles, correction rates, loss of correction, thoracic kyphotic angles (T5-T12), coronal balance, sagittal balance, and shoulder balance were measured on plain radiographs. Rib hump, operation time, estimated blood loss, spinal cord monitoring findings, complications, and scoliosis research society (SRS)-22 scores were also examined.



The mean preoperative curve of 58.0 degrees (range, 40-96 degrees) was corrected to a mean of 9.9 degrees postoperatively, and the correction rate was 83.6%. Fusion was obtained in all patients without loss of correction. In 10 cases with preoperative kyphosis angles (T5-T12) <10 degrees, the preoperative mean of 5.8 degrees improved to 20.2 degrees at the final follow-up. Rib hump and coronal, sagittal and shoulder balances were also improved, and good SRS-22 scores were achieved at final follow-up.



The correction of deformity with PSTH-DVR is equivalent to that of all-pedicle screw constructs. The procedure gives favorable correction, is advantageous for kyphosis compared with segmental screw fixation, and uses the minimum number of pedicle screws. Therefore, the PSTH-DVR procedure may be useful for treatment of idiopathic scoliosis.
*Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya†Department of Orthopaedic Surgery, National Center for Geriatrics and Gerontology, Obu‡Department of Orthopaedic Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Aichi§Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
Shiro
S
Imagama
Zenya
Z
Ito
Norimitsu
N
Wakao
Kei
K
Ando
Kenichi
K
Hirano
Ryoji
R
Tauchi
Akio
A
Muramoto
Hiroki
H
Matsui
Tomohiro
T
Matsumoto
Yoshihito
Y
Sakai
Yoshito
Y
Katayama
Yukihiro
Y
Matsuyama
Naoki
N
Ishiguro
D000293:Adolescent; D005260:Female; D006801:Humans; D016268:Internal Fixators; D007738:Kyphosis / Q000601:surgery; D008297:Male; D065289:Pedicle Screws; D011095:Polyethylenes / Q000627:therapeutic use*; D012600:Scoliosis / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation* / Q000379:methods*; D013904:Thoracic Vertebrae / Q000601:surgery; D014057:Tomography, X-Ray Computed
D011095:Polyethylenes; C111601:ultra-high molecular weight polyethylene