OBJECTIVE: Surgical technique with an anterior double-rod system for thoracic, thoracolumbar, or lumbar scoliosis. The aim of the system is to correct the coronal plane deformity and normalize the sagittal balance. INDICATIONS: Scoliosis which should have a coronal Cobb measurement of at least 40 degrees and should usually not exceed 90 degrees in between T4 and L4. In the Lenke classification, the curve types 1 (main thoracic) and curve type 5 (thoracolumbar/lumbar) are amenable to anterior instrumentation and fusion. CONTRAINDICATIONS: Osteoporosis. Infection. Allergic reaction to implants. Minor curves that do not correct to < 25 degrees on flexibility maneuvers. Structured kyphosis in the major curve. Severe sagittal plane malalignment with pathologic kyphosis cranial or caudal of the instrumented segments. SURGICAL TECHNIQUE: The spine is exposed via an open thoracotomy or a thoracoabdominal approach. After completion of diskectomies at each level, the anterior double-rod system is fixed with two bicortical screws per vertebral body. The longitudinal components consist of a solid rod and a threaded rod. The rods are contoured to maintain normal sagittal and coronal contour. The proximal screws are engaged first and then a cantilever force is used to correct the deformity. Occasionally, a partial rod rotation maneuver or intersegmental compression is performed. Morselized autograft (typically rib) is placed in the disk spaces. Intraoperative radiographs are taken to evaluate the correction. POSTOPERATIVE MANAGEMENT: Brace-free mobilization. Physiotherapy. Respiratory therapy. RESULTS: Very high rate of successful spondylodesis. Excellent frontal correction of about 60-70%. Very good spontaneous correction of adjacent minor curves of around 40%. Restoration of a physiological profile. Correction angle and length of fusion comparable to modern transpedicular double-rod systems.
OBJECTIVE: Surgical technique with an anterior double-rod system for thoracic, thoracolumbar, or lumbar scoliosis. The aim of the system is to correct the coronal plane deformity and normalize the sagittal balance. INDICATIONS: Scoliosis which should have a coronal Cobb measurement of at least 40 degrees and should usually not exceed 90 degrees in between T4 and L4. In the Lenke classification, the curve types 1 (main thoracic) and curve type 5 (thoracolumbar/lumbar) are amenable to anterior instrumentation and fusion. CONTRAINDICATIONS: Osteoporosis. Infection. Allergic reaction to implants. Minor curves that do not correct to < 25 degrees on flexibility maneuvers. Structured kyphosis in the major curve. Severe sagittal plane malalignment with pathologic kyphosis cranial or caudal of the instrumented segments. SURGICAL TECHNIQUE: The spine is exposed via an open thoracotomy or a thoracoabdominal approach. After completion of diskectomies at each level, the anterior double-rod system is fixed with two bicortical screws per vertebral body. The longitudinal components consist of a solid rod and a threaded rod. The rods are contoured to maintain normal sagittal and coronal contour. The proximal screws are engaged first and then a cantilever force is used to correct the deformity. Occasionally, a partial rod rotation maneuver or intersegmental compression is performed. Morselized autograft (typically rib) is placed in the disk spaces. Intraoperative radiographs are taken to evaluate the correction. POSTOPERATIVE MANAGEMENT: Brace-free mobilization. Physiotherapy. Respiratory therapy. RESULTS: Very high rate of successful spondylodesis. Excellent frontal correction of about 60-70%. Very good spontaneous correction of adjacent minor curves of around 40%. Restoration of a physiological profile. Correction angle and length of fusion comparable to modern transpedicular double-rod systems.