Combined anterior and posterior instrumentation in severe and rigid idiopathic scoliosis

A prospective clinical and radiographic evaluation of 33 consecutive patients with severe and rigid idiopathic scoliosis (average Cobb angle 93°, flexibility on bending films 23%) were treated with combined anterior and posterior instrumentation with a minimum follow-up of 2 years. All patients underwent anterior release and VDS-Zielke Instrumentation of the primary curve. In highly rigid scoliosis, this was preceded by a posterior release. Finally, posterior correction and fusion with a multiple hook and pedicle screw construct was performed. Thirty patients were operated in one stage, three patients in two stages. Preoperative curves ranged from 80 to 122° Cobb angle. Frontal plane correction of the primary curve averaged 67% with an average loss of correction of 2°. The apical vertebral rotation of the primary curve was corrected by 49%. In all but three patients, sagittal alignment was restored. There were no neurological complications, deep wound infections or pseudarthrosis. Combined anterior and posterior instrumentation is safe and enables an effective three-dimensional curve correction in severe and rigid idiopathic scoliosis.     

Is anterior release necessary in severe scoliosis treated by posterior segmental pedicle screw fixation?

With the advent of segmental pedicle screw fixation that enables more powerful corrective forces, it is postulated that an additional anterior procedure may be unnecessary even in severe deformities. The purpose of this paper is to evaluate the results of a posterior procedure alone using segmental pedicle screw fixation in severe scoliotic curves over 70°. Thirty-five scoliosis patients treated by pedicle screw fixation and rod derotation were retrospectively analyzed after a minimum follow-up of 2 years (range 2–10.4). The mean age of patients was 15.3 years (range 9.8–34.2). Diagnoses were idiopathic scoliosis in 29, neuromuscular scoliosis in 3 and scoliosis associated with Marfan syndrome in 3. Scoliosis consisted of single thoracic curve in 18, double thoracic in 5 and double major in 12. Twenty-five patients showed a major thoracic curve greater than 70° (range 70–100), and different ten patients showed a major lumbar curve greater than 70° (range 70–105), pre-operatively. The deformity angle, lowest instrumented vertebral tilt (LIVT) and spinal balance were measured. Pre-operatively there were nine patients with coronal decompensation. The pre-operative thoracic curve of 80 ± 9° with the flexibility of 45 ± 11% (45 ± 11° in side-bending film) was corrected to 27 ± 10° at the most recent follow-up, showing a correction of 66% (53°) and loss of correction of 3.0% (3.7°). The pre-operative lumbar curve of 79 ± 12° with the flexibility of 62 ± 14% (30 ± 11° in side-bending film) was corrected to 33 ± 14° at the most recent follow-up [59% (46°) curve correction, 3.5% (3.0°) loss of curve correction]. The pre-operative LIVT of 30 ± 8° was corrected to 11 ± 6°, showing a correction of 62% (19°). Residual coronal decompensation was observed in three patients postoperatively. Pre-operative thoracic kyphosis of 27° (range 0–82) improved postoperatively to 31° (range 14–53). In conclusion, posterior segmental pedicle screw fixation without anterior release in severe scoliosis had satisfactory deformity correction without significant loss of curve correction. In this series a posterior procedure alone obviated the need for the anterior release and avoided complications related anterior surgery.     

The technique of scoliosis revision surgery utilizing L-rod instrumentation

Operative treatment of failed scoliosis surgery requires an instrumentation that is readily adaptable to the multiple causes and sequelae of failed spinal surgery. A "modified L-rod" technique is described for segmental spinal instrumentation to treat failed scoliosis surgery. Nine patients underwent 10 scoliosis revision operations, with an average follow-up of 37.1 months. Three neuromuscular, five idiopathic, and one congenital scoliosis were revised. The average blood loss for the L-rod instrumentation was 2,960 ml, and the average operative time was 6.2 h. Four patients had attempted correction of their deformities, with 21.2% improvement. Five cases had triangular base-transverse bar pelvic fixation. None of the 10 revisions had pseudarthrosis at follow-up. No postoperative immobilization was used. Complications included one fracture of a fusion mass below the L-rods, penetration of the skin by a prominent wire with subsequent infection, minimal loss of correction in one case, and one broken wire without loss of correction.     

Surgical treatment of scoliosis associated with Marfan syndrome by using posterior-only instrumentation

Surgical treatment of scoliosis associated with Marfan syndrome poses a challenge to spine surgeons. This retrospective study was undertaken to determine whether posterior-only surgery with instrumented fixation and fusion addresses the correction of scoliosis and maintains curve correction. Twelve consecutive patients with Marfan syndrome were treated between 2002 and 2007 for scoliosis by posterior segmental instrumentation using pedicle screws or hybrid thoracic-hook and lumbar-screw constructs. Their preoperative Cobb angle averaged 66 ± 10° (range: 55-90°). The average operation time was 252 ± 36 min (range: 200-300 min) and the average blood loss was 690 ± 117 ml (range: 550-920 ml). No significant complications were found. All the patients were followed for a minimum of 2 years (range: 2.4-6.8 years). The average Cobb angle was corrected to 23 ± 8° (range: 13-35°) immediately after surgery and 28 ± 9° (range: 14-43°) with a correction rate of 58 ± 13% at final follow-up. The results indicate that posterior-only surgery with instrumented fixation and fusion is effective and safe for the treatment of scoliosis in selected patients with Marfan syndrome.     

Posterior spinal fusion: allograft versus autograft bone

The effectiveness of allograft bone for posterior spinal fusion in neuromuscular scoliosis is controversial. Thirty patients with cerebral palsy, treated with posterior spinal fusion, were divided into two groups. Group 1 consisted of 18 patients treated by posterior spinal fusion using autogenous bone graft. Group 2 consisted of 12 patients treated by posterior spinal fusion using freeze-dried allograft bone. The average preoperative curve of 70 degrees in Group 1 was corrected to 35 degrees (50% correction). At 3.2 years average follow-up, the curves averaged 51 degrees (46% loss of correction). The average preoperative curve of 80 degrees in Group 2 was corrected to 39 degrees (51% correction). At 3.5 years average follow-up, the curves averaged 54 degrees (38% loss of correction). Anesthesia time decreased from 344 to 281 minutes (p less than 0.05), and intraoperative blood loss decreased from 2730 to 1740 ml (p less than 0.025) when allograft bone was used as a substitute for autograft bone. Freeze-dried allograft bone is a readily available, safe, and effective substitute for autogenous bone graft in patients with cerebral palsy undergoing posterior spinal fusion.     

Rip hump correction and rotation of the lumbar spine after selective thoracic fusion

In this study a series of 32 patients with idiopathic scoliosis, managed with selective thoracic fusion, was reviewed. Classified according to King and instrumented with the H-frame, the patients were evaluated for curve correction, rib hump correction and postoperative shift in lumbar rotation. Age and follow-up averaged 19.4 and 2.4 years, respectively. The 32 patients had an average primary and lumbar curve correction of, respectively, 66% (6.0% correction loss) and 53% (3.4% correction loss). The respective values for postoperative rib hump correction and shift in apical lumbar rotation averaged 8° and 9.4° in type II King curves, 4.4° and 3.5° in type III and 11° and-5° in Type IV. Significant differences were noted between the curve types in rib hump correction and shift in lumbar rotation. The study showed that en bloc postoperative rotation of the compensatory lumbar segment, directed towards the rib hump, positively influences rib hump correction. This en bloc rotation of the unfused lumbar segments is induced by the correcting forces applied by the instrumentation. The unfused lumbar spine of a patient with a King type II curve shows a larger lumbar rotation shift and subsequent rib hump correction than that of a patient with a King type III curve. Together with factors such as lateral angulation, rib-vertebra angles and structural limitations, the rotational dynamics of the unfused lumbar spine seem to form an important component in the understanding and surgical management of scoliosis.     

极重度脊柱侧凸的二期手术治疗

目的探讨极重度脊柱侧凸患者的手术治疗方法。方法对11例极重度脊柱侧凸患者的二期手术治疗进行回顾性研究,其中男2例,女9例;年龄为11~17岁,平均13.4岁。Cobb角为130°~170°,平均159°。采用二次手术,一期将130°~170°极重度的脊柱侧凸矫正47%左右,将其变为重度脊柱侧凸,4~6个月后再采用常规方法进行二期矫形,使矫正率达到65%左右。一期手术行小切口手术,采用内撑开技术进行撑开。4~6个月以后再行二期手术,常规后路矫形,僵硬的病例可采用小关节突松解或者360°截骨,并进行剃刀背切除和植骨。结果二次术后Cobb角为46°~66°,平均58°。身高增加14~21cm,平均19.1cm。所有病例的手术均顺利完成,无严重并发症出现。结论对于极重度脊柱侧凸的患者采用二期手术治疗,可以明显提高畸形的矫正率,手术的安全性也得到了提高。     

Posterior-only unit rod instrumentation and fusion for neuromuscular scoliosis

STUDY DESIGN: A retrospective study to determine the efficacy of posterior-only unit rod instrumentation and fusion in a skeletally immature neuromuscular scoliosis population. OBJECTIVE: To determine whether the posterior-only approach to this population adequately addresses the concerns of correction of scoliosis and pelvic obliquity, maintenance of that correction over time, and the incidence of crankshaft phenomenon. SUMMARY OF BACKGROUND DATA: Controversy exists regarding the need for anterior release to improve curve flexibility and the need to obtain an anterior arthrodesis in those skeletally immature patients at risk for crankshafting with continued anterior growth. METHODS: From 1992 through 1997, 28 consecutive skeletally immature patients with neuromuscular scoliosis underwent posterior-only unit rod instrumentation and fusion for the treatment of progressive, symptomatic spinal deformities. Preoperative, immediate postoperative, and final follow-up radiographs were analyzed with respect to scoliosis and pelvic obliquity correction, maintenance of that correction over time, and the development of the crankshaft phenomenon as evidenced by loss of correction and/or increased rib-vertebral angle difference. The average age of the patients was 12.8 years and the average follow-up was 58 months with a minimum of 2 years. RESULTS: Twenty-six patients were available for final follow-up. The initial Cobb angle correction averaged 66%, with 75% of the pelvic obliquity corrected. These corrections were maintained over time. Before surgery 27 of 28 patients were Risser 0, 1, or 2. The triradiate cartilage was open in nine patients, and five patients were < or =10 years of age. At the final follow-up 22 of the 26 patients were Risser 5 and 4 were Risser 4. There was one patient with increased rib-vertebral angle difference over the length of follow-up, with no loss of frontal or sagittal plane alignment. CONCLUSIONS: These results indicate that even in the very young neuromuscular patient, acceptable amounts of curve correction can be achieved and maintained with posterior-only unit rod instrumentation and fusion. The biomechanical stiffness of this construct seemed to be able to prevent the crankshaft phenomenon in the majority of those patients at risk.     

Anterior and posterior spinal fusion for paralytic scoliosis

Twenty-three patients with paralytic scoliosis were treated with a combination of anterior and posterior spinal instrumentation and fusion. The sequence was anterior surgery first in 19 patients and posterior surgery first in 4. The average age was 14.4 years. Preoperative correction with a halo-hoop apparatus was performed in 12 patients. The average preoperative curve for the group measured 100 degrees, and the average postoperative curve at a mean follow-up time of 21 months was 37 degrees. The mean loss of correction was 8 degrees. Although superior hook dislodgment occurred in 5 patients, no pseudarthrosis or beinding of the fusion mass was documented.     

Anterior surgery with short fusion using the Zielke procedure for thoracic scoliosis: focus on the correction of compensatory curves

Anterior instrumentation is recommended to correct idiopathic thoracolumbar or lumbar scoliosis through short fusion within the major curve. Only a few reports exist of anterior surgical correction for thoracic scoliosis. This study assessed the results of Zielke instrumentation for thoracic curve and analyzed the three-dimensional correction of deformity, especially correction of the uninstrumented compensatory curve. Seventeen patients, who had undergone selective thoracic correction and fusion using the Zielke procedure to treat thoracic scoliosis, had been followed for at least 3 years. Three-dimensional correction was evaluated radiographically. Furthermore, three-dimensional back deformities were evaluated using a topographic body scanner. Twelve patients with a single thoracic curve and five with a double curve were all female, with a mean age of 14.6 years. The preoperative main thoracic curve was 54.8 degrees +/- 10.5 degrees (range, 40-78 degrees), and it was 23.8 degrees +/- 10.5 degrees (range, 7-40 degrees) at the final follow-up examination (p < 0.0001). The average correction rate of the main curves was 56.6%. By correcting the thoracic curve, the upper and lower compensatory curves were corrected spontaneously without surgical instrumentation, with average correction rates of 45.1% and 50.2%, respectively. The average correction loss of the main curve was 2.3 degrees. The hump angle measured using a topographic body scanner decreased from 12.8 degrees +/- 4.5 degrees to 8.4 degrees +/- 4.3 degrees after surgery (p = 0.0001). Of the three patients in whom the rod broke up, only one showed a correction loss of 10 degrees; however, bony fusion was obtained. Anterior short fusion for thoracic scoliosis appears to offer significant correction, stabilization, and spontaneous correction of the compensatory lumbar curve without limiting lumbar motion.     

Failed Primary Surgery in Congenital Scoliosis Caused by a Single Hemivertebra: Reasons and Revision Strategies

ObjectiveTo analyze the factors causing failure of primary surgery in congenital scoliosis (CS) patients with single hemivertebra (SHV) undergoing posterior spinal fusion, and to elucidate the revision strategies.MethodsIn this retrospective study, a total of 32 CS patients secondary to SHV undergoing revision surgery from April 2010 to December 2017 due to failed primary surgery with more than 2 years follow‐up were reviewed. The reasons for failure of primary surgery and revision strategies were analyzed for each patient. The radiographic parameters including coronal Cobb angle, segmental kyphosis (SK), coronal balance (CB), and sagittal vertical axis (SVA) were compared between pre‐ and post‐revision. The complications during revision and follow‐up were recorded.ResultsThe mean age at revision surgery of the 32 CS patients was 15.8 ± 9.7 years and the average duration between primary and revision surgery was 31.0 ± 35.4 months. The reasons for failed primary surgery were severe post‐operative curve progression of focal scoliosis in 14 cases (43.8%), implant failure in 17 (53.1%) and trunk imbalance in 12 (37.5%). The candidate revision strategies included thorough resection of residual hemivertebra and adjacent discs, extending fusion levels, complete pseudarthrosis resection, massive bone graft, replacement of broken rods, satellite rod fixation, horizontalization of upper/lower instrumented vertebrae and rigid fusion of structural compensatory curves were performed individually. After revision surgery, the coronal Cobb angle, SK, CB and SVA showed significant improvement (P < 0.05) with no significant correction loss during follow‐up (P > 0.05). The intra‐operative complications included alarming changes of neurologic monitoring in three (9.4%) patients and dual tear in two, while rod fracture re‐occurred was detected in one patient at 18 months after revision.ConclusionsThe common reasons for failed primary surgery in CS patients with SHV undergoing posterior spinal fusion were severe post‐operative curve progression of focal scoliosis, implant failure and trunk imbalance. The revision strategies including thorough resection of residual hemivertebra and adjacent discs, extended fusion levels to structural curvature, complete pseudarthrosis resection, massive bone graft, replacement of broken internal fixation and horizontalization of upper/lower instrumented vertebrae should be individualized based on the causes of failed primary surgery.     

Spine fusion in cerebral palsy with L-rod segmental spinal instrumentation. A comparison of single and two-stage combined approach with Zielke instrumentation

The benefits of achieving rigid internal fixation and eliminating the need for postoperative external orthotic support with L-rod spinal instrumentation made it desirable for use in the surgical treatment of neuromuscular scoliosis. From May 1981 to May 1985, 31 severely involved cerebral palsy patients with progressive spinal deformity underwent posterior fusion and L-rod instrumentation. All patients except one were nonambulatory. Surgical indications included prevention of curve progression, correction of pelvic obliquity, and achievement of balanced spinal alignment in order to improve sitting balance and tolerance without external spinal orthotic support. Ten patients (Group I), with an average age of 15.2 years, with double major or flexible paralytic C-curves or scoliosis measuring less than 70 degrees, underwent posterior fusion and L-rod instrumentation only. Twenty-one patients (Group II), with an average age of 22.1 years, with thoracolumbar, lumbar, or rigid paralytic C-curves or scoliosis measuring greater than 70 degrees, underwent initial anterior release, bone grafting, and Zielke instrumentation followed by second-stage L-rod instrumentation. In Group I, scoliosis averaged 57 degrees and postoperatively 27 degrees (53% correction). In Group II, scoliosis averaged 88 degrees and postoperatively 36 degrees (63% correction). Fifteen Group II patients had posterior fusion extend into the sacrum using the Galveston technique. Six Group II patients were not fused into the sacrum. Scoliosis and pelvic obliquity were corrected in both groups. Torso decompensation improved to 2.7 cm in the Galveston group, but increased to 5.6 cm at follow-up in the patients not fused into the sacrum.(ABSTRACT TRUNCATED AT 250 WORDS)     

Anterior thoracoscopic surgery followed by posterior instrumentation and fusion in spinal deformity

Many authors believe thoracoscopic surgery is associated with a lower level of morbidity compared to thoracotomy, for anterior release or growth arrest in spinal deformity. Others believe that anterior release achieved thoracoscopically is not as effective as that achieved with the open procedure. We evaluated the clinical results, radiological correction and morbidity following anterior thoracoscopic surgery followed by posterior instrumentation and fusion, to see whether there is any evidence for either of these beliefs. Twenty-nine patients undergoing thoracoscopic anterior release or growth arrest followed by posterior fusion and instrumentation were evaluated from a clinical and radiological viewpoint. The mean follow-up was 2 years (range 1–4 years). The average age was 16 years (range 5–26 years). The following diagnoses were present: idiopathic scoliosis (n = 17), neuromuscular scoliosis (n = 2), congenital scoliosis (n = 1), thoracic hyperkyphosis (n = 9). All patients were satisfied with cosmesis following surgery. Twenty scoliosis patients had a mean preoperative Cobb angle of 65.1° (range 42°–94°) for the major curve, with an average flexibility of 34.5% (42.7°). Post operative correction to 31.5° (50.9%) and 34.4° (47.1%) at maximal follow-up was noted. For nine patients with thoracic hyperkyphosis, the Cobb angle averaged 81° (range 65°–96°), with hyperextension films showing an average correction to 65°. Postoperative correction to an average of 58.6° was maintained at 59.5° at maximal follow-up. The average number of released levels was 5.1 (range 3–7) and the average duration of the thoracoscopic procedure was 188 min (range 120–280 min). There was a decrease in this length of time as the series progressed. No neurologic or vascular complications occurred. Postoperative complications included four recurrent pneumothoraces, one surgical emphysema, and one respiratory infection. Thoracoscopic anterior surgery appears a safe and effective technique for the treatment of paediatric and adolescent spinal deformity. A randomised controlled trial, comparing open with thoracoscopic methods, is required. Received: 11 October 1999 Revised: 20 April 2000 Accepted: 16 May 2000     

Survivorship analysis of Cotrel-Dubousset instrumentation in idiopathic scoliosis

This study presents a survivorship analysis of Cotrel-Dubousset instrumentation in the surgical treatment of idiopathic scoliosis. Between 1987 and 1995, a total of 133 patients with idiopathic scoliosis received posterior spine fusion and instrumentation with the CD system at our center. The patients' mean age at surgery was 16.5 years (range 11–43 years). The magnitude of the thoracic scoliosis averaged 62.7° (range 40°–125°) and that of the lumbar curve was 58.8° (range 40°–100°). On average, 12.2 segments were fused (range 8–17) and, excluding the rods, 14.1 implants were set for each patient (range 10–21). Survivorship analysis was carried out using the Kaplan-Meier method. Implant removal was considered the terminal event, or "death". The effect of several variables on survival rate was determined with the Cox regression method. The patients remained in the study for 56.7 months (range 2–120 months). One-hundred and ten patients were withdrawn ("censored"): 90 "alive" (did not require repeat surgery and attended follow-up control in 1997) and 20 "lost" (did not attend control in 1997). Twenty-three patients attained the terminal event of implant removal for a variety of reasons: acute infection (three cases), late infection (ten cases), implant failure requiring revision (six cases) and local pain (four cases). The survival rate was 95.5% at 3 months, 94.7% at 6 months, 93.9% at 1 year, 91.5% at 2 years, 82.2% at 5 years and 76.5% at 10 years. The magnitude of the curves, total number of implants and number of fused segments did not correlate with survival probability. A positive correlation was found between survival rate and correction loss between surgery and last control. A survival rate of 76.5% at 10 years is unexpectedly low. Current data suggest that the incapacity to maintain correction after initial surgery plays a major roll in the long-term evolution of Cotrel-Dubousset instrumentation.     

节段性椎弓根钉系统治疗伴发脊髓空洞的脊柱侧凸

目的 评价节段性椎弓根钉系统治疗伴发脊髓空洞的脊柱侧凸的手术疗效.方法 应用节段性椎弓根钉系统治疗伴发脊髓空洞的脊柱侧凸35例.合并Chiari Ⅰ型畸形12例(34.3%).典型侧凸18例,不典型侧凸 17例.所有患者术前均未接受任何针对脊髓卒洞的治疗措施.手术分组:(1)一次手术组(30例):患者手术年龄>10岁,一次性后路节段性椎弓根钉系统矫形内固定植骨融合术.(2)二次手术组(5例):患者年龄≤10岁,一期手术行可自行延长的节段性椎弓根钉系统矫形手术,4～6年后行二期矫形内同定植骨融合术.结果 术前冠状面主弯Cobb角平均66.5°(32°～121°);术后平均22.6°(0°～78°),平均矫正率69.4%(31%～100%);平均随访58.4(13～113)个月,末次随访时冠状面主弯Cobb角3°～78°,平均25.9°.最终矫正率63.9%.6例随访时出现追加现象,其中5例融合下端椎没有融合至稳定椎.术后出现腹壁反射消失1例,浅感觉减退范围扩大1例,未予处理.结论 对于伴发未经治疗的非扩张型脊髓窄洞的脊柱侧凸,如果术前无或仅伴随轻微神经损害症状,可以直接采用后路节段性椎弓根钉系统进行矫形治疗.建议对这类脊柱侧凸远端应融合至稳定椎.     

MW construct in fusion for neuromuscular scoliosis

A retrospective case control review was conducted to determine if the MW construct offers a superior means of correction of Cobb angles and pelvic obliquity in neuromuscular scoliosis. Posterior spinal fusion (PSF) in patients with neuromuscular scoliosis presents a surgical challenge. Particularly difficult is the correction of pelvic obliquity. Numerous instrumentation techniques have sought to address these difficulties. Most recently Arlet et al have introduced the MW construct. (in Eur Spine 8(3):229–231, 1999). They theorize that this construct may allow for superior spinopelvic fixation. Six patients with neuromuscular scoliosis who underwent PSF with the MW construct were compared with six subjects undergoing PSF utilizing the Galveston technique. Subjects were matched on the basis of preoperative Cobb angles and similar amounts of preoperative pelvic obliquity. Individuals who underwent PSF utilizing the MW construct obtained nearly 30% better correction of pelvic obliquity than did those who received a Galveston construct. A trend toward superior correction of Cobb angles with the MW construct was also observed. The MW construct may be a superior construct for curve correction in PSF for neuromuscular scoliosis, particularly those cases with excessive pelvic obliquity.     

Surgical treatment of adult scoliosis. A review of two hundred and twenty-two cases

We evaluated the cases of 222 patients older than twenty years in whom scoliosis was the primary diagnosis. No patient had had prior surgical treatment. The diagnoses were idiopathic scoliosis in 160 patients, paralytic scoliosis in forty-four, and congenital scoliosis in eleven, and there were miscellaneous diagnoses in seven patients. The average age of the patients when first seen was 30.7 years. The indications for operation were pain, progression of the curve, magnitude of the curve, and cardiopulmonary symptoms. Preoperative traction, including halo-femoral traction, did not result in increased correction when compared with the initial supine side-bending roentgenogram. A one-stage fusion was performed in 174 patients and multiple-stage procedures, in forty-eight patients. At an average follow-up of 3.6 years the average loss of correction was 6.2 degrees, 68 per cent of the patients were free of pain, and a solid fusion had been obtained in all but six patients. Complications developed in 53 per cent of the patients, the most common problems being pseudarthrosis, urinary tract infection, wound infection, instrumentation problems, a pulmonary disorder, and loss of lumbar lordosis. Paraplegia occurred in one patient. The over-all mortality rate was 1.4 per cent. Complications increased with age, and the highest mortality rate was in patients with congenital scoliosis who had cor pulmonale.     

Subtransverse process wiring: a new technique of segmental spinal fixation of the thoracic spine or in the treatment of adolescent idiopathic scoliosis.

STUDY DESIGN: Segmental fixation is the preferred technique for the surgical treatment of adolescent idiopathic scoliosis. Sublaminar wiring is a widely used, strong type of segmental fixation. The most common drawback of the sublaminar wiring is the risk of neurologic injury. The authors have applied subtransverse wiring for 3 years, and the technique seems promising. OBJECTIVES: To show that subtransverse wiring is a technique strong enough to correct scoliosis curves and does not carry neurologic injury risks. SUMMARY OF BACKGROUND DATA: Sublaminar wiring is a commonly used fixation method for posterior fusion in the treatment of scoliosis. Because of its associated risk of neurologic injury, it is mostly recommended for long neuromuscular curves. METHODS: The authors used the subtransverse wiring technique in 12 cases of adolescent idiopathic scoliosis and followed them for an average of 22 months. RESULTS: The average correction rate was 65%, and correction loss at the end of the follow-up period was 5 degrees. No neurologic complications were encountered. CONCLUSIONS: Subtransverse wiring is strong enough to correct scoliotic curves. It requires less operative time and skill and is neurologically safe.     

Modified Luque–Galveston procedure for stabilisation of neuromuscular scoliosis and pelvic obliquity: results from a specialist paediatric spinal unit

Aim  The objective of this paper is to describe a modified method and to present our results for stabilization of the vertebral column to the pelvis in patients with neuromuscular scoliosis. This technique attempts to address difficulties posed by distal fixation in such cases. Methods  A retrospective review of nine consecutive patients with neuromuscular scoliosis was carried out. All patients in this group had surgical correction between 1999 and 2002. Results  Immediate post-operative mean corrections of 65.1° (Cobb angle) and 10.6° (pelvic obliquity) were obtained. Mean follow-up time was 39 months (range: 36–48). Mean operating times of 497 min and mean blood loss of 57.2 ml/kg body weight were achieved. All patients reached clinical and radiological spinal fusion with no loss of correction seen at latest follow-up visit. Conclusion  Obtaining adequate distal fixation with the standard Luque–Galveston technique can be difficult in patients with neuromuscular scoliosis who often have a porotic pelvis. These difficulties can be minimised by the modified technique described in this paper.     

Spinal fusion augmented by luque-rod segmental instrumentation for neuromuscular scoliosis

Seventy-four patients who had deformity of the spine secondary to a neuromuscular disorder were treated using posterior fusion with Luque-rod segmental instrumentation. The mean curve was 73 degrees preoperatively and 38 degrees postoperatively. The mean loss of correction was 4 degrees at an average duration of follow-up of forty-two months (range, 2.0 to 7.3 years). Complications included one death, three deep wound infections, two pressure sores, six sets of broken rods, and one instance of distal rotation and migration of the rod. There were no major perioperative neurological complications. Failure of instrumentation occurred more frequently with 3/16-inch (4.8-millimeter) diameter than with 1/4-inch (6.4-millimeter) diameter stainless-steel rods. There was a tendency for cephalad progression of deformity when the fusion ended cephalad at or below the fourth thoracic vertebra. We concluded that Luque-rod segmental instrumentation with posterior spinal fusion is an effective treatment for patients who have neuromuscular scoliosis.