We evaluated the radiographic results of posterior spinal arthrodesis with use of Cotrel-Dubousset instrumentation in seventy-six patients who had adolescent idiopathic scoliosis. At an average of six years (range, five to ten years) postoperatively, the fusion appeared to be solid in all patients. Comparison of radiographs that had been made immediately postoperatively with those that had been made at the time of the latest follow-up showed that no patient had lost any correction in the coronal plane at the levels with instrumentation and seventy-five had had no change in the thoracic or lumbar sagittal alignment at the levels with or without instrumentation. In the remaining patient, a kyphosis had developed at the junction of the segments with instrumentation and those without instrumentation, necessitating additional operative treatment. Sixty-three patients completed a questionnaire for assessment of the clinical status. Their responses were favorable with regard to function, cosmetic appearance, and general satisfaction with the operative result. Twenty-four (38 per cent) of the sixty-three patients reported occasional pain in the spine that did not interfere with work or school activities. Sixty-two patients stated that, given the hypothetical situation of reverting to the preoperative status, they would have the operation again.
Study Design. A prospective evaluation of adolescent idiopathic scoliosis patients undergoing operative treatment on the Orthopedic Systems Incorporated (OSI; Jackson) frame. Objectives. To investigate prospectively thoracic, thoracolumbar, and lumbar sagittal alignments in patients with adolescent idiopathic scoliosis who undergo an instrumented posterior spinal fusion on the OSI frame. Summary of Background Data. In several studies, it has been shown that patient positioning on various operative frames is an important component of ultimate lumbar sagittal alignment. However, these studies have all concentrated on the lumbar spine, and no sagittal plane alignment data in adolescent idiopathic scoliosis patients have been reported in the thoracic and thoracolumbar junction as it relates to intraoperative positioning, correction maneuvers, and correlative postoperative results. Methods. Thirty-nine patients with operative adolescent idiopathic scoliosis treated with an instrumented posterior spinal fusion on the OSI frame were prospectively evaluated. Standing preoperative, intraoperative, and postoperative long-cassette lateral radiographs were reviewed with regional and segmental Cobb measurements of the thoracic, thoracolumbar junction, and lumbar spine obtained. Results. Thoracic kyphosis (T1-T12) measured +34° before surgery, +28° during surgery, and +30° after surgery. Thus, a statistically significant decrease was noted in thoracic kyphosis secondary to prone positioning on the OSI frame (P < 0.05). Thoracolumbar spine measurements from T10 to L2 also showed a lordotic trend from +2° before surgery, to −4° during surgery, to −8° after surgery, which was also statistically significant (P < 0.05). Total lumbar lordosis from T12 to S1 remained relatively unchanged from −60° before surgery, to −59° during surgery, to −60° after surgery. However, segmental lumbar lordosis measured from T12 to the lowest instrumented vertebra showed a statistically significant increase in lordosis from −17° before surgery, to −19° during surgery, to −23° after surgery (P < 0.05). Those patients in whom lumbar pedicle screws were used (vs. hooks alone) had the greatest increase in lumbar instrumented lordosis. Conclusions. Performing adolescent idiopathic scoliosis correction on the OSI frame tends to decrease thoracic kyphosis, increase thoracolumbar lordosis, and increase segmental instrumented lumbar lordosis, while it maintains total lumbar lordosis.
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