Derotation of the Scoliotic Spine

Derotation of the Scoliotic Spine

Stefan Parent


Adolescent idiopathic scoliosis (AIS) is the most common form of spinal deformities, and its surgical treatment has evolved over the years from a simple spine arthrodesis to a more complex surgical procedure involving the use of instrumentation and better corrective strategies. The challenge in this procedure has shifted from the perioperative morbidity of the procedure to the long-term evaluation of radiographic and quality of life outcomes. The single most important objective remains the prevention of long-term progression of the scoliotic deformity and prevention of long-term sequelae. Additionally, obtaining a well-balanced pain-free spine has been set as a standard criterion for success. Great strides have been made in the last 20 years to better correct the spinal deformity, and great strides have been made to better correct the different aspects of the trunk deformity and not rely solely on the correction of the spinal deformity to achieve improvement in trunk shape. This chapter focuses on the different steps involved in correcting the spinal deformity including the torsional aspects of the deformity. Although different variations of these corrective techniques exist, the technique described herein is commonly referred to as direct vertebral derotation (DVD).


An excellent way to better appreciate the 3D spinal deformity is through the use of 3D reconstructions based on two orthogonal views of the spine acquired in the standing position. The system used at our institution to obtain 3D reconstruction is the EOS system, which provides two orthogonal views at a fraction of the radiation dose of other common radiologic systems. The 3D reconstructions obtained have a precision of 1 mm compared to CT scan reconstruction at 1/1,000th of the dose and provide information in the standing position for a given patient. These 3D reconstructions give access to views of the spine that are not easily accessible or even possible using standard radiographs. One can therefore better appreciate the hypokyphosis seen in scoliotic deformities as well as abrupt changes in the sagittal profile of different scoliotic segments of the deformed spine.

Jun 13, 2016 | Posted by in ORTHOPEDIC | Comments Off on Derotation of the Scoliotic Spine

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