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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