Copyright
©The Author(s) 2018.
World J Orthop. Sep 18, 2018; 9(9): 138-148
Published online Sep 18, 2018. doi: 10.5312/wjo.v9.i9.138
Published online Sep 18, 2018. doi: 10.5312/wjo.v9.i9.138
Table 1 Operative and postoperative data among our patient groups
Group | Type of scoliosis | No. ofpatients | Mean age at surgery (yr) | Procedure (No. of patients) | Operatingtime (min) | Blood loss(mL) | Bloodloss (BV) | Mean follow-up (yr) | Complications |
A - Complex deformity | Syndromic | 21 | 13 | PSF: 19; A/PSF: 2 | 164 | 727 | 27 | 3.0 | 2 rod breakages-one revision required due to non-union; 1 distal junctional kyphosis-distal fusion extension required |
Early onset idiopathic | 17 | 11 | PSF: 11; A/PSF: 6 | 185 | 519 | 25 | 2.9 | None | |
Congenital | 13 | 11 | PSF: 13 | 138 | 368 | 13 | 4.8 | One rod breakage-no revision required | |
Neuromuscular | 5 | 14 | PSF: 5 | 125 | 662 | 24 | 3.0 | None | |
Intraspinal anomalies | 6 | 13 | PSF: 6 | 145 | 525 | 22 | 4.5 | None | |
B - Conversion of growing rods to definitive fusion | Early onset | 21 | 12 | PSF: 17; A/PSF: 4 | 159 | 497 | 20 | 2.8 | None |
C - AIS | Adolescent idiopathic | 16 | 15.8 | PSF: 16 | 128 | 406 | 9 | 2.8 | None |
Summary of data | 99 | 13 | PSF: 87; A/PSF: 12 | 153 | 530 | 20 | 3.2 | 4 |
Table 2 Type and size of deformity among our patients in groups A and B
Group | Type of scoliosis | No. of patients | Thoracic scoliosis (meanpreop/postop; degrees);(%correction) | Double thoracic scoliosis(mean preop/postop;degrees); (%correction) | Thoracic/lumbar scoliosis(mean preop/postop; degrees);(%correction) | Triple thoracic/lumbar scoliosis(mean preop/postop; degrees);(%correction) | Thoracic kyphoscoliosis(mean preop/postop;degrees); (%correction) |
A – Complex deformity | Syndromic | 21 | 78/30 (62%); 8 patients | Upper TH: 46/19 (59%) main TH: 60/24 (60%); 5 patients | TH: 55/18 (67%) L: 43/15 (65%); 4 patients | Upper TH: 32/6 (81%) main TH: 61/28 (54%) L: 52/25 (52%); 2 patients | Scoliosis: 120/48 (60%) kyphosis: 103/60 (42%); 2 patients |
Early onset idiopathic | 17 (infantile: 9; juvenile: 8) | 99/34 (66%); 4 patients | Upper TH: 53/25 (53%) main TH: 81/47 (42%); one patient | TH: 89/36 (60%) L: 70/27 (61%); 6 patients | Upper TH: 49/15 (69%) main TH: 84/30 (64%) L: 52/20 (62%); 5 patients | Scoliosis: 56/31 (45%) kyphosis: 122/65 (47%); one patient | |
Congenital | 13 | 58/36 (38%); 6 patients | Upper TH: 39/22 (44%) main TH: 76/40 (47%); 2 patients | TH: 75/38 (49%) L: 68/36 (47%); 3 patients | Upper TH: 41/15 (63%) main TH: 55/25 (55%) L: 44/22 (50%); one patient | Scoliosis: 70/31 (56%) kyphosis: 75/35 (53%); one patient | |
Neuromuscular | 5 | 66/19 (71%); 2 patients | - | TH: 79/31 (61%) L: 65/28 (57%); 3 patients | - | - | |
Associated with intraspinal anomalies | 6 | 82/36 (56%); 6 patients | - | - | - | ||
B – Conversion of growing rods to definitive fusion | Syndromic | 10 | 91/39 (57%); 6 patients | - | TH: 93/52 (44%) L: 69/37 (46%); 4 patients | - | - |
Infantile idiopathic | 6 | 74/28 (62%); 2 patients | Upper TH: 59/34 (42%) main TH: 100/55 (45%); one patient | TH: 61/38 (38%) L: 101/52 (49%); one patient | - | Scoliosis: 63/32 (49%) kyphosis: 104/61 (41%); 2 patients | |
Congenital | 4 | 77/38 (51%); 4 patients | - | - | - | - | |
Neuromuscular | 1 | - | - | - | - | Scoliosis: 65/25 (62%) kyphosis: 78/50 (36%); one patient |
Table 3 Patients with syndromic conditions included in our study
Group A – Complex deformity (n = 21 patients) | Group B - Conversion of growing rods to definitive fusion (n = 10 patients) |
Neurofibromatosis type 1 (2) | Skeletal dysplasia (2) |
Osteogenesis imperfecta (1) | Oculo-auriculo-fronto-nasal syndrome (1) |
Rubinstein-Taybi type 2 (1) | Chromosome abnormality (7) |
Cystic Fibrosis (1) | |
Arthrogryposis multiplex congenital (1) | |
Ehlers-Danlos (1) | |
Angelman’s (1) | |
Marfan’s (1) | |
Prader-Willi (1) | |
Down’s syndrome (1) | |
Chromosome abnormality (4) | |
Undiagnosed syndromic condition (6) |
Table 4 Type and size of deformity before and after surgery among our patients with adolescent idiopathic scoliosis and severe eczema (group C)
Patientnumber | Gender | Risser grade | Scoliosis type(No. ofpatients)[9] | Procedure(posterior spinalfusion/levels) | Upper thoracic scoliosis(pre-op/post-op;degrees); (% correction) | Main thoracic scoliosis(pre-op/post-op;degrees); (% correction) | Lumbar scoliosis (pre-op/post-op; degrees);(%correction) | Kyphosis (pre-op/post-op);(degrees) | Lordosis (pre-op/post-op);(degrees) | Coronal balance(pre-op/post-op);(cm) | Sagittal balance (pre-op/post-op); (cm) |
1 | F | 5 | 2A | PSF T2-T10 | 52/23 (56%) | 49/22 (55%) | - | 19/52 | 49/52 | 0/0 | -3.5/0 |
2 | F | 5 | 1B | PSF T3-T11 | - | 48/15 (69%) | 35/17 (51%- spontaneous correction) | 27/52 | 47/53 | 0.3/0 | -2.8/0 |
3 | M | 2 | 2A | PSF T2-L1 | 32/11 (66%) | 47/11 (77%) | - | 35/44 | 40/42 | 0.8/0 | -0.8/0 |
4 | F | 4 | 1A | PSF T2/T9 | - | 45/0 (100%) | - | 45/55 | 55/58 | 2.3/0 | -0.3/0 |
5 | M | 5 | 2A | PSF T2-T11 | 32/12 (62.5%) | 52/16 (69%) | 30/6 (80%-spontaneous correction) | 23/44 | 59/45 | 0.8/0 | -3.1/0 |
6 | F | 5 | 3C | PSF T2-L4 | - | 55/12 (78%) | 48/10 (79%) | 25/50 | 40/50 | 1.2/0 | -2.8/0 |
7 | F | 5 | 2B | PSF T3-T12 | 35/12 (66%) | 55/21 (62%) | 36/11 (69%-spontaneous correction) | 28/48 | 50/50 | 1/0 | -3.0/0 |
8 | M | 4 | 1A | PSF T2-T12 | - | 60/15 (75%) | 39/10 (74%-spontaneous correction) | 16/38 | 43/42 | 0/0 | 1.5/0 |
9 | F | 3 | 2A | PSF T3-T12 | 29/9 (69%) | 48/14 (71%) | 30/2 (93%-spontaneous correction) | 17/38 | 33/38 | 0.6/0 | -1.2/0 |
10 | F | 3 | 1A | PSF T2-T11 | - | 52/20 (61.5%) | 36/15 (58%-spontaneous correction) | 24/46 | 61/51 | 0/0 | -2.5/0 |
11 | M | 5 | 1B | PSF T2-T11 | - | 55/16 (71%) | 30/15 (50%-spontaneous correction) | 20/48 | 47/50 | 3.5/0 | 4.1/0 |
12 | F | 4 | 2A | PSF T3-T12 | 32/11 (66%) | 59/17 (71%) | 32/13 (59%-spontaneous correction) | 46/48 | 57/46 | 0.8/0.2 | -3.5/-1 |
13 | M | 4 | 1A | PSF T2-T11 | - | 52/15 (71%) | 30/15 (50%-spontaneous correction) | 20/47 | 48/46 | 3/0 | 3.5/0 |
14 | F | 5 | 2B | PSF T2-T11 | 42/15 (64.3%) | 60/25 (58.3%) | 40/14 (65%-spontaneous correction) | 31/48 | 46/47 | 1.2/0.5 | -2.3/0 |
15 | F | 4 | 2A | PSF T3-T12 | 39/14 (64%) | 69/23 (67%) | 37/14 (62%-spontaneous correction) | 31/47 | 45/50 | 0.5/0 | -0.5/0 |
16 | F | 3 | 2A | PSF T3-L2 | 22/8 (64%) | 59/20 (66%) | 28/9 (68%-spontaneous correction) | 56/54 | 54/53 | 2.5/0.3 | 2.2/0 |
Summary of data | 11 F; 5 M | Mean: 4.1 | Scoliosis type 1 (1); 2 (2); 3 (6); 4 (7) | 15 TH fusions; one TH/L fusion | Mean values: 35/12.7 (64%) | Mean values: 54/16 (70.4%) | Mean values: 35/11.6 (67%) | Mean values: 29/47.4 (63.4%) | Mean values: 48/48 no change | Mean values: 1.16/0.06 (95%) | Mean values: 2.35/0.06 (97.4%) |
Table 5 Cost analysis and comparison between the single and double rod constructs in the treatment of adolescent idiopathic scoliosis based on the Universal Spinal System instrumentation
No. of levels included | Type of construct | Instrumentation | Comparative cost |
10 (thoracic fusion) | Double rod construct with bilateral segmental pedicle screws (implant density: 2) | 20 pedicle screws 20 sleeves and nuts 2 rods | 100% |
Double rod construct using the authors’ preferred technique (implant density: 1.38)[10] | 14 pedicle screws 14 sleeves and nuts 2 rods | 29% reduction compared to bilateral segmental pedicle screw construct | |
Single rod hybrid construct | 3 pedicle screws 3 pedicle screw hooks 1 transverse process hook 7 sleeves and nuts 1 rod | 65% reduction compared to bilateral segmental pedicle screw construct; 51% reduction compared to authors’ preferred technique | |
15 (Thoracic and Lumbar fusion) | Double rod construct with bilateral segmental pedicle screws (implant density: 2) | 30 pedicle screws 30 sleeves and nuts 2 rods | 100% |
Double rod construct using authors preferred technique (implant density: 1.38)[10] | 21 pedicle screws 21 sleeves and nuts 2 rods | 29% reduction compared with bilateral segmental pedicle screw construct | |
Single rod construct | 6 pedicle screws 5 pedicle screw hooks 1 transverse process hook 12 sleeves and nuts 1 rod | 64% reduction compared to bilateral segmental pedicle screw construct; 49% reduction compared to authors’ preferred technique |
- Citation: Tsirikos AI, Loughenbury PR. Single rod instrumentation in patients with scoliosis and co-morbidities: Indications and outcomes. World J Orthop 2018; 9(9): 138-148
- URL: https://www.wjgnet.com/2218-5836/full/v9/i9/138.htm
- DOI: https://dx.doi.org/10.5312/wjo.v9.i9.138