8 Long-Term Outcomes of Operative Management in Adolescent Idiopathic Scoliosis

10.1055/b-0038-160339

8 Long-Term Outcomes of Operative Management in Adolescent Idiopathic Scoliosis

Manabu Ito, Katsuhisa Yamada, and Ekkaphol Larpumnuayphol

Introduction

The history of surgical treatment for adolescent idiopathic scoliosis (AIS) dates back 100 years ago. 1 After the advent of metallic spinal implants to correct spinal deformity in the middle of 20th century, the ability to correct spinal deformity has shown significant improvement. 2 Because most patients who undergo surgical treatment of AIS are younger than 20 years of age, their life expectancy after the primary surgery is longer than 50 years. To assess the lifelong value of deformity correction surgery for AIS, long-term follow-up studies on the effects of surgical treatment on patients’ health-related parameters are indispensable. This chapter discusses the long-term clinical results of posterior and anterior surgery for AIS, based on studies with a minimum of 10 years of follow-up ( Table 8.1 ). The parameters addressed include the correction rate of scoliotic deformity in each surgical procedure, surgery-related complications, rates and causes of revision surgery, long-term pulmonary function, and lumbar disk degeneration below the lowest instrumented vertebra (LIV). The purpose of surgery in the adolescent is to prevent the consequences of deformity progression in adulthood. An important question remains regarding whether surgical treatment for AIS in children would prevent further progression of lumbar disk degeneration and residual spinal deformity and would help avoid severe deformity-related clinical problems in later years.

Table 8.1 Long-Term (> 10 Years) Follow-Up Reports of the Clinical Results of Posterior and Anterior Surgery for Adolescent Idiopathic Scoliosis

 

PMID Number

Author

Journal

Year

Number of Subjects

Average Follow-Up Period in Years (Range)

Instrumentation

1

25996533

Iida T

Spine

2015

51 (Harrington 49, Luque 2)

22.6 (20–29)

Harrington or Luque

2

23595075

Sudo H

J Bone Joint Surg Am.

2013

32 (Lenke type 5C)

17.2 (12–23)

Anterior dual-rod instrumentation KASS

3

23169073

Sudo H

Spine

2013

25 (Lenke 1 MT)

15.2 (12–18)

Anterior spinal fusion (ASF) KASS

4

23064806

Min K

Eur Spine J

2013

48 Lenke 1 (A = 19, B = 8, C = 14), 7 Lenke 2 (lumbarmodifier A = 2, B = 4, C = 1)

10

Posterior with all PS instrumentation

5

22037534

Akazawa T

Spine

2012

66

31.5 (21–41)

Posterior 58 (Harrington 45, Harrington with wiring 6, Chiba solid rod 7), anterior 8 (Dwyer 3, Zielke5)

6

21971127

Larson AN

Spine

2012

28 (AIS 1B,1C,3C)

19: selective thoracic fusion

9: long fusion

20 (14–24)

TSRH or CD instrumentation

7

21494198

Gitelman Y

Spine

2011

49

10.7 (8–16)

Group 1A (n = 17): open anterior spinal fusion/instrumentation

Group 1B (n = 9): combined open anteroposterior spinal fusion

Group 1C (n = 12): posterior spinal fusion/instrumentation with thoracoplasty

Group 2 (n = 11): posterior spinal fusion/instrumentation

8

21289549

Green DW

Spine

2011

20

11.8 (9.4–15.1)

Posterior fusion and segmental instrumentation (10: hybrid w/dual rods, PS, hook, wire; 9: dual rods all hook; 1: dual rods hook, wire)

9

20081516

Kelly DM

Spine

2010

18

16.97 (12–22)

Anterior spinal fusion (Dwyer, TSRH, or Zielke)

10

19910755

Bartie BJ

Spine

2009

171

19

Harrington

11

19752706

Takayama K

Spine

2009

32 (AIS 18)

21.1

Harrington: 7, CD: 8, Zielke: 2, Dwyer: 1

12

19713874

Takayama K

Spine

2009

32 (AIS 18)

21.1

Harrington: 7, CD: 8, Zielke: 2, Dwyer: 1

13

18519315

Helenius I

J Bone Joint Surg Am

2008

190

14.8

14

17762812

Bjerkreim I

Spine

2007

44 single primary curves

10 (EQ, ODI), 5 (Xp)

CD

15

16924553

Benli IT

Eur Spine J

2007

109

11.3

TSRH

16

16449899

Danielsson AJ

Spine

2006

135

23.2 ± 1.6(20.3–26.5)

Harrington

17

15864669

Mariconda M

Eur Spine J

2005

24

22.9(20.2–27.3)

Single Harrington distraction rod

18

15706345

Helenius I

Spine

2005

Harrington:11 pairs, Cotrel-Dubousset:9 pairs, USS:10 pairs

Males 14.3(6.7–23.0), Females 14.1(6.4–23.7)

Harrington in 11 pairs, CD in 9 pairs, USS in 10 pairs

19

15526199

Niemeyer T

Int Orthop.

2005

41

23 (11–30)

Harrington

20

15371703

Remes V

Spine

2004

CD:57; USS:55

CD: 13.0(11.2–15.0), USS 7.8(6.1–10.5)

CD or USS

21

14668498

Helenius I

J Bone Joint Surg Am.

2003

57

13

CD

22

14501939

Danielsson AJ

Spine

2003

139

23.2(20.3–26.6)

Harrington

23

12131746

Götze C

Spine

2002

82

16.7 (11–22)

Harrington

24

11805664

Helenius I

Spine

2002

78

20.8(19.1–22.4)

Harrington

25

11563612

Danielsson AJ

Eur Spine J.

2001

146

23.3(20.3–26.6)

Harrington

26

11389396

Padua R

Spine

2001

70

23.7 (15–28)

Harrington

27

11242379

Danielsson AJ

Spine

2001

139

23.2(20.3–26.6)

Harrington

28

11259948

Danielsson AJ

Acta Radiol.

2001

32

23.2

Harrington

29

10984785

Pérez-Grueso FS

Spine

2000

35

Minimum 10

CD

30

7642667

Connolly PJ

J Bone Joint Surg Am

1995

83

12 (10–16)

Harrington

31

2326715

Kohler R

Spine

1990

21 lumbar/thoracolumbar

Minimum 10

Dwyer

32

2141336

Dickson JH

J Bone Joint Surg Am.

1990

206

21

Harrington

Abbreviations: AIS, adolescent idiopathic scoliosis; CD, Cotrel and Dubousset instrumentation; KASS, Kaneda Anterior Scoliosis System instrumentation; MT, midthoracic; ODI, Oswestry Disability Index; PS, pedicle screw; TSRH, Texas Scottish Rite Hospital instrumentation; USS, Universal Spine System instrumentation.

History of Surgical Treatment for Adolescent Idiopathic Scoliosis

In the 1910s and 1920s, Russell Hibbs 1 performed long, uninstrumented insitu posterior spinal fusion followed by a long-lasting immobilization with a cast. At the end of 1950s, Paul Harrington 2 was the first to use metallic spinal implants to correct spinal deformity and to enhance spinal fusion. He introduced a hook and rod system for concave-distraction and convex-compression ( Fig. 8.1 ). The next development was initiated by Eduardo Luque, 3 who uses sublaminar stainless-steel wires in combination with L-shaped rods in the 1970s. He used the implant for treatment of neuromuscular scoliosis and later for idiopathic scoliosis. The next generation of spinal instrumentation surgery was introduced by Cotrel and Dubousset 4 (CD instrumentation) at the beginning of the 1980s. They introduced a new concept of deformity correction, the rod rotation maneuver, to correct not only scoliosis but also rotational deformity of the deformed spine. CD instrumentation incorporates a frame construct consisting of two rods with multiple hooks ( Fig. 8.2 ). Similar spinal instrumentation systems, including the Texas Scottish Rite Hospital (TSRH) instrumentation (Dallas, TX), Isola Spine System (Raynham, MA) ( Fig. 8.3 ), and Moss-Miami system (DePuy, Warsaw, IN), had been introduced subsequently around the year 1990. These instruments consisted of two rods with multiple hooks, sublaminar wires, and pedicle screws. Modern sublaminar implants such as titanium cables and high-molecular polyester bands have been developed recently to prevent metal corrosion and to protect the spinal cord.

Fig. 8.1 Preoperative (a,b) and postoperative (c,d) radiographs of Harrington instrumentation (single distraction rod and two hooks).
Fig. 8.2 Preoperative (a,b) and postoperative (c,d) radiographs of CD instrumentation (two rods and multiple hooks).
Fig. 8.3 Preoperative (a,b) and postoperative (c,d) radiographs of a hybrid system (ISOLA; two rods, hooks, sublaminar wires, and distal pedicle screws).

After Suk et al 5 reported the use of pedicle screws (PSs) for scoliosis correction in 1995, PS instrumentation became a standard operative technique for idiopathic scoliosis around the year 2000 ( Fig. 8.4 ). This transpedicular fixation systems enabled the surgeon to achieve better three-dimensional correction of scoliosis than with previous systems by allowing surgeons to use all available corrective techniques, such as derotation, translation, segmental distraction–compression, and insitu bending of rods. 6 During the past 10 years, there have been significant developments in PS instrumentation with new correction techniques such as direct vertebral rotation (DVR), 7 simultaneous dual rod rotation, and others. 8

Fig. 8.4 Preoperative (a,b) and postoperative (c,d) radiographs of all–pedicle screw systems.

With regard to anterior instrumentation for AIS, the Dwyer system was the first system introduced in 1970s. 9 Anterior systems consist of vertebral screws introduced on the convexity of the curve, with a flexible cable between the screws on which a compression force was applied on the convex side of the curve. This system was modified by Zielke with a threaded rod, and with a solid rod in the TSRH system. In the 1980s, the Kaneda device was developed for thoracolumbar-lumbar burst fractures. In 1989, the Kaneda device was modified to a multisegmental anterior spinal system and was used for correction of thoracolumbar scoliosis. 10 A unique character of Kaneda device was that it consisted of two rods and two vertebral screws in each vertebral body for biomechanical superiority and restoration of sagittal alignment of the spine ( Fig. 8.5 ). As a minimally invasive surgery for thoracic curves, video-assisted thoracoscopic techniques (VATSs) have been utilized since the 1990s. 11 The technique involves anterior diskectomy and fusion with single rod instrumentation under endoscopic guidance, and it is commonly used for mild thoracic curves. Due to the recent development of posterior correction surgery, the current practice is that anterior surgery for AIS is conducted in selective cases with thoracolumbar and lumber curves.

Fig. 8.5 Preoperative (a,b) and postoperative (c,d) radiographs of KASS (two vertebral screws and rods) for a thoracolumbar curve.

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May 21, 2020 | Posted by in ORTHOPEDIC | Comments Off on 8 Long-Term Outcomes of Operative Management in Adolescent Idiopathic Scoliosis

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