ANTERIOR INSTRUMENTATION IN SURGERY FOR LUMBAR AND THORACOLUMBAR IDIOPATHIC SCOLIOSIS
https://doi.org/10.14531/ss2017.2.21-30
Abstract
Objective. To analyze the long-term results of surgical correction of idiopathic scoliosis in the lumbar and thoracolumbar spine with anterior instrumentation.
Material and Methods. A total of 24 patients (mean age - 18.2 years, male/female ratio - 3/21) were operated on using anterior two-rod instrumentation system. The mean operating time was 170 minutes, and the mean blood loss - 374 ml. The average postoperative follow-up period was 50 months.
Results. The primary curve was reduced from 48.7° to 14.8°º (69.6 %). Postoperative progression was 6.4°. Thoracic counter-curve underwent self-correction from 27.7° to 14.7°, postoperative progression was 3.0°. The thoracic kyphosis and lumbar lordosis remained within the normal ranges. Rotation of the apical vertebra before the operation was 27.8 %, immediately after the intervention - 17.5 %, at the end of the follow-up period - 17.1 %. Coronal imbalance before surgery was 24.7 mm, immediately after the intervention - 27.5 mm, at the end of the follow-up period - 7.1 mm. The patients’ self-evaluation of treatment outcomes was carried out using the Russian version of the SRS-24 questionnaire. At the first follow-up visit, patients reported expectedly lower postoperative function score and gave middle scores for the remaining domains. Later, there was a positive dynamics in all assessed parameters, most pronounced in pain syndrome, function and overall activity after surgery.
Conclusion. Correction of idiopathic scoliosis of lumbar and thoracolumbar localization using anterior instrumentation is a highly effective method of treatment, which in most cases gives a stable positive result. However, the development of pronounced trunk imbalance in some patients requires the continuation of studies in order to optimize the technique for determining the optimal extent of the instrumented fusion.
About the Authors
Mikhail Vitalyevich MikhaylovskiyRussian Federation
Aleksandr Sergeyevich Vasyura
Russian Federation
Vyacheslav Viktorovich Novikov
Russian Federation
Vladimir Nikolayevich Sarnadsky
Russian Federation
Elena Vladimirovna Gubina
Russian Federation
Anastasia Igorevna Podrezova
Russian Federation
References
1. Ветрилэ С.Т., Кулешов А.А., Ветрилэ М.С., Кисель А.А. Хирургическое лечение грудопоясничного и поясничного сколиоза // Хирургия позвоночника. 2004. № 2. С. 12-18.
2. Ветрилэ С.Т., Кулешов А.А., Швец В.В., Ветрилэ М.С. Особенности течения и оперативного лечения диспластического поясничного и грудопоясничного сколиоза у детей и взрослых // Вестник травматологии и ортопедии им. Н.Н. Приорова. 2011. № 2. С. 71-80.
3. Губина Е.В. Клиническое применение русскоязычного варианта анкеты Scoliosis Research Society Outcomes Instrument-24 (SRS-24) // Хирургия позвоночника. 2004. № 2. С. 34-39.
4. Дулаев А.К., Надулич К.А., Ястребков Н.М. Первый опыт коррекции сколиотической деформации поясничного отдела позвоночника методом деротационного вентрального спондилодеза // VII съезд травматологов-ортопедов России: Тез. докл. Новосибирск, 2002. С. 134.
5. Колесов С.В., Кудряков С.А., Шавырин И.А., Мельников И.И. Особенности коррекции сколиотических деформаций позвоночника из вентрального доступа // Хирургия позвоночника. 2009. № 4. С. 15-20. DOI: http://dx.doi.org/10.14531/ss2009.4.15-20.
6. Сарнадский В.Н., Садовой М.А., Фомичев Н.Г. Способ компьютерной оптической топографии тела человека и устройство для его осуществления. Заявл. 26.08.96. Евразийский патент № 000111.
7. Bitan FD, Neuwirth MG, Kuflik PL, Casden A, Bloom N, Siddiqui S. The use of short and rigid anterior instrumentation in the treatment of idiopathic thoracolumbar scoliosis. A retrospective review of 24 cases. Spine. 2002;27:1553-1557.
8. Bullmann V, Halm HF, Niemeyer T, Hackenberg L, Liljenqvist U. Dual-rod correction and instrumentation of idiopathic scoliosis with the Halm-Zielke instrumentation. Spine. 2003;28:1306-1313. DOI: 10.1097/01.BRS.0000065571.58058.68.
9. Dwyer AF, Schafer MF. Anterior approach to scoliosis. Results of treatment in fifty-one cases. J Bone Joint Surg Br. 1974;56:218-224.
10. Geck MJ, Rinella A, Hawthorne D, Macagno A, Koester L, Sides B, Bridwell K, Lenke L, Shufflebarger H. Comparison of surgical treatment in Lenke 5C adolescent idiopathic scoliosis: anterior dual rod versus posterior pedicle fixation surgery. A comparison of two practices. Spine. 2009;34:1942-1951. DOI: 10.1097/BRS.0b013e3181a3c777.
11. Hee HT, Yu ZR, Wong HK. Comparison of segmental pedicle screw instrumentation versus anterior instrumentation in adolescent idiopathic thoracolumbar and lumbar scoliosis. Spine. 2007;32:1533-1542. DOI: 10.1097/BRS.0b013e318067dc3d.
12. Huitema GC, Jansen RC, van Ooij A, Punt IM, van Rhijn LW. Predictability of spontaneous thoracic curve correction after anterior thoracolumbar correction and fusion in adolescent idiopathic scoliosis. A retrospective study on a consecutive series of 29 patients with a minimum follow-up of 2 years. Spine J. 2015;15:966-970. DOI: 10.1016/j.spinee.2013.06.013.
13. Kaneda K, Shono Y, Satoh S, Abumi K. New anterior instrumentation for the management of thoracolumbar and lumbar scoliosis. Application of the Kaneda two-rod system. Spine. 1996;21:1250-1262.
14. Kelly DM, McCarthy RE, McCullough FL, Kelly HR. Long-term outcomes of anterior spinal fusion with instrumentation for thoracolumbar and lumbar curves in adolescent idiopathic scoliosis. Spine. 2010;35:194-198. DOI: 10.1097/BRS.0b013e3181bc948e.
15. Lowe TG, Alongi PR, Smith DA, O’Brien MF, Mitchell SL, Pinteric RJ. Anterior single rod instrumentation for thoracolumbar adolescent idiopathic scoliosis with and without the use of structural interbody support. Spine. 2003;28:2232-2242. DOI: 10.1097/01.BRS.0000085028.70985.39.
16. Lowe TG, Peters JD. Anterior spinal fusion with Zielke instrumentation for idiopathic scoliosis. A frontal and sagittal curve analysis in 36 patients. Spine. 1993;18:423-426. DOI: 10.1097/00007632-199303010-00002.
17. Li M, Ni J, Fang X, Liu H, Zhu X, He S, Gu S, Wang X. Comparison of selective anterior versus posterior screw instrumentation in Lenke5C adolescent idiopathic scoliosis. Spine. 2009;34:1162-1166. DOI: 10.1097/BRS.0b013e31819e2b16.
18. Luo M, Wang W, Shen M, Xia L. Anterior versus posterior approach in Lenke 5C adolescent idiopathic scoliosis: a meta-analysis of fusion segments and radiological outcomes. J Orthop. Surg Res. 2016;11:77. DOI: 10.1186/s13018-016-0415-9.
19. Nambiar M, Yang Y, Liew S, Turner PL, Torode IP. Single- versus dual-rod anterior instrumentation of thoracolumbar curves in adolescent idiopathic scoliosis. Eur Spine J. 2016;25:3249-3255. DOI: 10.1007/s00586-015-4360-9.
20. Nash CL Jr, Moe JH. A study of vertebral rotation. J Bone Joint Surg Am. 1969;51:223-229.
21. Otani K, Saito M, Sibasaki K. Anterior instrumentation in idiopathic scoliosis: a minimum follow-up of 10 years. Int Orthop. 1997;21:4-8. DOI: 10.1007/s002640050108.
22. Quellet JA, Johnson CE 2nd. Effect of grafting technique on the maintenance of coronal and sagittal correction in anterior treatment of scoliosis. Spine. 2002;27:2129-2136. DOI: 10.1097/01.BRS.0000025682.74729.CF.
23. Sanders AE, Baumann R, Brown H, Johnston CE 2nd, Lenke LG, Sink E. Selective anterior fusion of thoracolumbar/lumbar curves in adolescents. When can the associated thoracic curve be left unfused? Spine. 2003;28:706-714. DOI: 10.1097/01.BRS.0000051925.88443.85.
24. Senkoylu A, Luk KD, Wong YW, Cheung KM. Prognosis of spontaneous thoracic curve correction after the selective anterior fusion of thoracolumbar/lumbar (Lenke 5C) curves in idiopathic scoliosis. Spine J. 2014;14:1117-1124. DOI: 10.1016/j.spinee.2013.07.467.
25. Smith JA, Deviren V, Berven S, Bradford DS. Does instrumented anterior scoliosis surgery lead to kyphosis, pseudarthrosis, or inadequate correction in adults? Spine. 2002;27:529-534.
26. Sudo H, Kaneda K, Shono Y, Iwasaki N. Short fusion strategy for thoracolumbar and lumbar adolescent idiopathic scoliosis using anterior dual-rod instrumentation. J Bone Joint Surg Br. 2016;98:402-409. DOI: 10.1302/0301-620X.98B3.36715.
27. Sudo H, Kaneda K, Shono Y, Iwasaki N. Selection of the upper vertebra to be instrumented in the treatment of thoracolumbar and lumbar adolescent idiopathic scoliosis by anterior correction and fusion surgery using dual-rod instrumentation: a minimum 12-year follow-up study. Spine J. 2016;16:281-287. DOI: 10.1016/j.spinee.2015.08.021.
28. Verma K, Auerbach JD, Kean KE, Chamas F, Vorsanger M, Lonner BS. Anterior spinal fusion for thoracolumbar scoliosis. Comprehensive assessment of radiographic, clinical, and pulmonary outcomes on 2-years follow-up. J Pediatr Orthop. 2010;30:664-669. DOI: 10.1097/BPO.0b013e3181ec931b.
29. White SF, Asher MA, Lai SM, Burton DC. Patients’ perceptions of overall function, pain, and appearance after primary posterior instrumentation and fusion for idiopathic scoliosis. Spine. 1999;24:1693-1700.
30. Wang Y, Fei Q, Qiu G, Lee CI, Shen J, Zhang J, Zhao H, Zhao Y, Wang H, Yuan S. Anterior spinal fusion versus posterior spinal fusion for moderate lumbar/thoracolumbar adolescent idiopathic scoliosis. A prospective study. Spine. 2008;33:2166-2172. DOI: 10.1097/BRS.0b013e318185798d.
31. Zielke K, Pellin B. Ergebnisse operativer Scoliosen- und Kyphoscoliosenbahandlung beim Adolescenten uber 18 Jahre und beim Erwachsenen. Z Orthop. 1975;113:157-174.
Review
For citations:
Mikhaylovskiy M.V., Vasyura A.S., Novikov V.V., Sarnadsky V.N., Gubina E.V., Podrezova A.I. ANTERIOR INSTRUMENTATION IN SURGERY FOR LUMBAR AND THORACOLUMBAR IDIOPATHIC SCOLIOSIS. Russian Journal of Spine Surgery (Khirurgiya Pozvonochnika). 2017;14(2):21-30. https://doi.org/10.14531/ss2017.2.21-30