ADOLESCENT IDIOPATHIC SCOLIOSIS WITH LENKE TYPE V AND VI CURVES: POSSIBILITIES OF MODERN SEGMENTAL INSTRUMENTATION
https://doi.org/10.14531/ss2017.4.18-26
Abstract
To analyze long-term results of surgical correction and postoperative quality of life in patients with Lenke type V and VI deformities of the spine.
Material and Methods. The treatment results of 61 patients (average age 15 years) with Lenke type V–VI spinal deformities and mean follow-up period of 3.3 years were analyzed. The average length of anterior fusion was 12.7 segments. The average length of the primary curve instrumented with pedicle screws was 4.9 segments.
Results. The primary curve was 56.6°, after surgical intervention it was reduced to 15.1° (73.3 % correction). Postoperative progression within 3.3 years was 2.1°. Thoracic countercurve was 40.6°, after surgery it was corrected to 15.0° (63.0 % correction). At the final follow-up examination, the thoracic curve was 17.3° (progression 2.3°). Thoracic kyphosis and lumbar lordosis were within the normal ranges. The frontal imbalance was 22.1 mm before surgery and 12.2 mm at the final follow-up examination. The SRS-24 questionnaire data showed a significant score increase in all seven domains.
Conclusion. Transpedicular fixation allows achieving a high degree of Lenke type V–VI spinal deformity correction with a stable result and significant improvement in the quality of life of patients.
About the Authors
Mikhail V. Mikhaylovskiy
Novosibirsk Research Institute of Traumatology and Orthopaedics n.a. Ya.L. Tsivyan
Russian Federation
Russian Federation
DMSc, Prof., Head of Department of Children and Adolescent Spine Surgery, Novosibirsk Research Institute of Traumatology and Orthopaedics n.a. Ya.L.Tsivyan
Frunze str., 17, Novosibirsk, 630091
Aleksandr S. Vasyura
Novosibirsk Research Institute of Traumatology and Orthopaedics n.a. Ya.L. Tsivyan
Russian Federation
Russian Federation
MD, PhD, senior researcher, traumatologist-orthopedist in the Department of Children and Adolescent Spine Surgery, Novosibirsk Research Institute of Traumatology and Orthopaedics n.a. Ya.L. Tsivyan
Frunze str., 17, Novosibirsk, 630091
Vyacheslav V. Novikov
Novosibirsk Research Institute of Traumatology and Orthopaedics n.a. Ya.L. Tsivyan
Russian Federation
Russian Federation
DMSc, senior researcher, traumatologist-orthopedist in the Department of Children and Adolescent Spine Surgery, head of functional unit of children and adolescent spine surgery, Novosibirsk Research Institute of Traumatology and Orthopaedics n.a. Ya.L. Tsivyan
Frunze str., 17, Novosibirsk, 630091
Vladimir N. Sarnadskiy
METOS Medical Topographic Systems Ltd
Russian Federation
Russian Federation
PhD in Technical Science, managing director of the METOS Medical Topographic Systems Ltd
Novosibirsk
Elena V. Gubina
Novosibirsk Research Institute of Traumatology and Orthopaedics n.a. Ya.L. Tsivyan
Russian Federation
Russian Federation
MD, PhD, senior researcher in the Clinic of Pediatric Orthopaedics, Novosibirsk Research Institute of Traumatology and Orthopaedics n.a. Ya.L. Tsivyan
Frunze str., 17, Novosibirsk, 630091
References
1. Васюра А.С., Новиков В.В., Белозеров В.В., Удалова И.Г. Эффективность применения ламинарной и транспедикулярной фиксации при хирургическом лечении идиопатического сколиоза поясничной и грудопоясничной локализации // Хирургия позвоночника. 2012. № 1. С. 48–53. [Vasyura AS, Novikov VV, Belosyorov VV, Udalova IG. Efficacy of laminar and transpedicular fixation in surgical treatment of thoracolumbar and lumbar idiopathic scoliosis. Hir. Pozvonoc. 2012;(1):48–53. In Russian]. DOI: http://dx.doi.org/10.14531/ss2012.1.48-53.
2. 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. [Vetrile ST, Kuleshov AA, Vetrile MS, Kisel’ AA. Surgical treatment of thoracolumbar and lumbar scoliosis. Hir Pozvonoc. 2004;(2):12–18. In Russian].
3. Виссарионов С.В., Надиров Н.Н., Белянчиков С.М., Кокушин Д.Н., Мурашко В.В., Картавенко К.А. Оперативное лечение детей с грудопоясничным идиопатическим сколиозом транспедикулярными спинальными системами // Ортопедия, травматология и восстановительная хирургия детского возраста. 2015. Т. 3. № 3. С. 15–20. [Vissarionov SV, Nadirov NN, Belyanchikov SM, Kokushin DN, Murashko VV, Kartavenko KA. Surgical treatment of children with idiopathic thoracolumbar scoliosis using transpedicular spinal systems. Pediatric Traumatology, Orthopaedics, and Reconstructive Surgery. 2015;3(3):15–20. In Russian]. DOI: 10.17816/PTORS3315-20.
4. Виссарионов С.В., Надиров Н.Н., Белянчиков С.М., Кокушин Д.Н. Хирургическая коррекция деформации позвоночника у детей с идиопатическим сколиозом поясничной локализации транспедикулярными спинальными системами // Детская хирургия. 2015. Т. 19. № 6. С. 4–7. [Vissarionov SV, Nadirov NN, Belyanchikov SM, Kokushin DN. Surgical correction of spine deformity in children with idiopathic lumbar scoliosis with the use of transpedicular spinal systems. Russian Journal of Pediatric Surgery. 2015;19(6):4–7. In Russian].
5. Виссарионов С.В., Соболев А.В., Надиров Н.Н., Кокушин Д.Н., Ефремов А.М., Белянчиков С.М. Сравнительный анализ эффективности хирургического лечения детей с идиопатическим сколиозом грудопоясничной и поясничной локализации // Фундаментальные исследования. 2015. № 1 (6). С. 1132–1137. [Vissarionov SV, Sobolev AV, Nadirov NN, Kokushin DN, Efremov AM, Beljanchikov SM. Comparative analysis of surgical treatment of children with idiopathic scoliosis of thoracolumbar and lumbar spine. Fundamental Research. 2015;(1–6):1132–1137. In Russian].
6. Bennett JT, Hoashi JS, Ames RJ, Kimball JS, Pahys JM, Samdani AF. The posterior pedicle screw construct: 5-year results for thoracolumbar and lumbar curves. J Neurosurg Spine. 2013;9:658–663. DOI: 10.3171/2013.8.SPINE12816.
7. Dwyer AF, Schafer MF. Anterior approach to scoliosis: results of treatment in fiftyone cases. J Bone Joint Surg Br. 1974;56:218–224.
8. Geck MJ, Rinella A, Hawthome 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.
9. Haher TR, Gorup JM, Shin TM, Homel P, Merola AA, Grogan DP, Pugh L, Lowe TG, Murray M. Results of the Scoiliosis Research Society instrument for evaluation of surgical outcome in adolescent idiopathic scoliosis. A multicenter study of 244 patients. Spine. 1999;24:1435–1540. DOI: 10.1097/00007632-199907150-00008.
10. Hall J, Gray J, Allen M. Dwyer instrumentation and spinal fusion. A follow-up study. J Bone Jt Surg. 1977;1:117.
11. Halm H, Niemeyer T, Link T, Liljenqvist U. Segmental pedicle screw instrumentation in idiopathic thoracolumbar and lumbar scoliosis. Eur Spine J. 2000;9:191–197. DOI: 10.1007/s005860000139.
12. Hsu LC, Zucherman J, Tang SC, Leong JC. Dwyer instrumentation in the treatment of adolescent idiopathic scoliosis. J Bone Joint Surg Br. 1982;64:536–541.
13. 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.
14. Chen J, Yang C, Ran B, Wang Y, Wang C, Zhu X, Bai Y, Li M. Correction of Lenke 5 adolescent idiopathic scoliosis using pedicle screw instrumentation: does implant density influence the correction? Spine. 2013;38:E946–E951. DOI: 10.1097/BRS.0b013e318297bfd4.
15. Kaneda K, Shono Y, Satoh S, Abumi K. New anterior instrumentation for the management of thoracolumbar and lumbar scoliosis. Application of the Kaneda tworod system. Spine. 1996;21:1250–1262. DOI: 10.1097/00007632-199605150-00021.
16. Lenke LG, Betz RR, Harms J, Bridwell KH, Clements DH, Lowe TG, Blanke K. Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis. J Bone Joint Surg Am. 2001;63:1169–1181. DOI: 10.2106/00004623-200108000-00006.
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 Lenke 5C adolescent idiopathic scoliosis. Spine. 2009;34:1162–1166. DOI: 10.1097/BRS.0b013e31819e2b16.
18. Okada E, Watanabe K, Pang L, Ogura Y, Takahashi Y, Hosogane N, Toyama Y, Matsumoto M. Posterior correction and fusion surgery using pedicle-screw constructs for Lenke type 5C adolescent idiopathic scoliosis: a preliminary report. Spine. 2015;40:25–30. DOI: 10.1097/BRS.0000000000000652.
19. Roberts SB, Tsirikos AI, Subramanian AS. Posterior spinal fusion for adolescent idiopathic thoracolumbar/lumbar scoliosis: clinical outcomes and predictive radiological factors for extension of fusion distal to caudal end vertebra. Bone Joint J. 2014;96:1082–1089. DOI: 10.1302/0301-620X.96B8.33837.
20. Shufflebarger HL, Geck MG, Clark CE. The posterior approach for lumbar and thoracolumbar adolescent idiopathic scoliosis: posterior shortening and pedicle screws. Spine. 2004;29:269–276. DOI: 10.1097/01.BRS.0000109881.63411.48.
21. Suk SI, Lee CK, Chung SS. Comparison of Zielke ventral derotation system and Cotrel-Dubousset instrumentation in the treatment of idiopathic lumbar and thoracolumbar scoliosis. Spine. 1994;19:419–429.
22. 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.
23. Wang Y, Bunger CE, Zhang Y, Wu C, Li H, Dahl B, Hansen ES. Lowest instrumented vertebra selection for Lenke 5C scoliosis: a minimum 2-year radiographical follow-up. Spine. 2013;38:E894–E900. DOI: 10.1097/BRS.0b013e31829537be.
24. Zielke K, Pellin B. [Results of surgical management of scoliosis and kyphoscoliosis in adults (author’s transl)]. Z Orthop Ihre Grenzgeb. 1975;113:157–174. In German. 2008;33:2166–2172. DOI: 10.1097/BRS.0b013e318185798d.
Review
For citations:
Mikhaylovskiy M.V., Vasyura A.S., Novikov V.V., Sarnadskiy V.N., Gubina E.V. ADOLESCENT IDIOPATHIC SCOLIOSIS WITH LENKE TYPE V AND VI CURVES: POSSIBILITIES OF MODERN SEGMENTAL INSTRUMENTATION. Russian Journal of Spine Surgery (Khirurgiya Pozvonochnika). 2017;14(4):18-26. https://doi.org/10.14531/ss2017.4.18-26
Email this article 