Abstract
Objective: To assess the radiological and back surface correction achieved following anterior USS in the treatment of thoracic adolescent idiopathic scoliosis (AIS).
Design: Prospective study of back surface correction, retrospective radiological review.
Subjects: 14 patients with thoracic AIS (age 11–18 yrs) were treated with anterior USS between 1995 and 2000. There are 12 females and 2 males, all with 2 year follow-up. 8 patients have complete surface data. Data from a further 6 patients will shortly be available as they reach 2 year follow-up.
Outcome measures: Cobb angle, apical vertebral rotation (AVR), apical vertebral translation (AVT), frontal plane imbalance, kyphosis and lordosis were measured from the radiographs. A Scoliometer was used to assess the maximal angle of trunk inclination (max ATI) in the thoracic region. All measurements were obtained before surgery and at 8 weeks, 1 year and 2 years after surgery. Complications were recorded.
Results: Significant initial corrections are observed for each of: Cobb angle (51%, p< 0.001), AVR (40%, p=0.003),AVT (64%,p< 0.001),maxATI (47%,p=0.001). There is no significant correction loss during the 2 year follow-up. Three patients had spinal imbalance (> 2cm) before surgery with one patient after surgery. The kyphosis significantly increased from 24° to 29° immediately after surgery with no significant change during follow-up. There was no change in lordosis. There were no neurological complications and no instrumentation failures were observed. In two cases the upper screw partially pulled out of T5 with some loss of correction.
Conclusions: Anterior scoliosis correction for thoracic AIS achieves good and stable radiological and particularly back surface corrections (max ATI – 47% compared with 22% correction after posterior surgery). Rigid anterior instrumentation has eliminated the 20% rod failure seen with Zielke. New techniques for preventing upper screw pull out will be discussed and new retractor systems allow smaller thoracotomies. There remains a small but significant increase in kyphosis which is less of a problem in the thoracic spine than at the thoracolumbar junction where anterior scoliosis correction is most commonly advocated.
Anterior instrumentation for thoracic AIS has advanced to a point where it can be widely adopted, particularly if the patient expresses concerns regarding the rib hump or is hypokyphotic.
The abstracts were prepared by Mr Peter Millner. Correspondence should be addressed to Peter Millner, Consultant Spinal Surgeon, Orthopaedic Surgery, Chancellor Wing, Ward 28 Office Suite, St James’ University Hospital, Beckett Street, Leeds LS9 7TF.
