Sebastien Pesenti1, Jean-Luc Clément2, Brice Ilharreborde3, Christian Morin4, Yann Philippe Charles5, Henri François Parent6, Philippe Violas7, Marc Szadkowski8, Louis Boissière9, Jean-Luc Jouve10, Federico Solla2. 1. Pediatric Orthopedics, CHU Timone, Aix MArseille University, Marseille, France. seb.pesenti@gmail.com. 2. Department of Pediatric Orthopedics and Scoliosis Surgery, Hôpitaux Pédiatriques de Nice Chu Lenval, 57 Avenue de la Californie, 06200, Nice, France. 3. Department of Pediatric Orthopedics, CHU Robert Debré, AP-HP, University of Paris, 48 Bd Sérurier, 75019, Paris, France. 4. Department of Pediatric Orthopedics, Institut Calot, rue du Dr Calot, 62600, Berck sur mer, France. 5. Department of Spine Surgery, Fédération de Médecine Translationnelle (FMTS), Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, 1 Avenue Molière, 67200, Strasbourg, France. 6. Spine Center, 6 rue de Belliniere, 49800, Trelaze, France. 7. Department of Pediatric Surgery, Hôpital Sud, CHU de Rennes, 16 Boulevard de Bulgarie, 35200, Rennes, France. 8. Santy Orthopedic Center, 24 avenue Paul Santy, 69008, Lyon, France. 9. Department of Orthopaedic Surgery, Spine Unit, CHU Bordeaux Pellegrin, Place Amélie Raba Léon, 33076, Bordeaux, France. 10. Pediatric Orthopedics, CHU Timone, Aix MArseille University, Marseille, France.
Abstract
INTRODUCTION: When performing posterior spinal fusion for adolescent idiopathic scoliosis (AIS), it is of major importance to address both coronal and sagittal deformities. Although several techniques have been described, few data exist comparing them. Our objective was to compare four techniques (in situ bending (ISB), rod derotation (RD), cantilever (C) and posteromedial translation (PMT)) for the correction of spinal deformity in AIS including thoracic deformity. MATERIAL AND METHODS: We conducted a multicenter retrospective study including 562 AIS patients with thoracic deformity with at least 24-month follow-up. Radiographic analysis was performed preoperatively, postoperatively and at last follow-up. The main outcomes were main curve correction and thoracic kyphosis restoration (TK). RESULTS: Coronal correction rate was significantly different among the four treatment groups (ISB 64% vs C 57% vs RD 55% vs PMT 67%, p < 0.001). Multivariate regression revealed that correction technique did not influence correction rate, whereas implant density, convex side compression and use of derotation connectors did. TK increase was significantly higher in the PMT group (average + 13°) than in DR (+ 3°), while ISB (-3°) and cantilever (-13°) resulted in TK decrease (p < 0.001). Multivariate analysis revealed that TK increase was only influenced by the reduction technique (p < 0.001) and preoperative TK (p < 0.001). DISCUSSION: The four techniques had the same ability to correct spinal deformity in the coronal plane. Three factors were identified to improve correction rate: implant density, convex compression and use of derotation connectors. On the other hand, PMT was more effective in restoring TK, particularly in hypokyphotic patients.
INTRODUCTION: When performing posterior spinal fusion for adolescent idiopathic scoliosis (AIS), it is of major importance to address both coronal and sagittal deformities. Although several techniques have been described, few data exist comparing them. Our objective was to compare four techniques (in situ bending (ISB), rod derotation (RD), cantilever (C) and posteromedial translation (PMT)) for the correction of spinal deformity in AIS including thoracic deformity. MATERIAL AND METHODS: We conducted a multicenter retrospective study including 562 AIS patients with thoracic deformity with at least 24-month follow-up. Radiographic analysis was performed preoperatively, postoperatively and at last follow-up. The main outcomes were main curve correction and thoracic kyphosis restoration (TK). RESULTS: Coronal correction rate was significantly different among the four treatment groups (ISB 64% vs C 57% vs RD 55% vs PMT 67%, p < 0.001). Multivariate regression revealed that correction technique did not influence correction rate, whereas implant density, convex side compression and use of derotation connectors did. TK increase was significantly higher in the PMT group (average + 13°) than in DR (+ 3°), while ISB (-3°) and cantilever (-13°) resulted in TK decrease (p < 0.001). Multivariate analysis revealed that TK increase was only influenced by the reduction technique (p < 0.001) and preoperative TK (p < 0.001). DISCUSSION: The four techniques had the same ability to correct spinal deformity in the coronal plane. Three factors were identified to improve correction rate: implant density, convex compression and use of derotation connectors. On the other hand, PMT was more effective in restoring TK, particularly in hypokyphotic patients.
Authors: S Delorme; H Labelle; C E Aubin; J A de Guise; C H Rivard; B Poitras; J Dansereau Journal: Spine (Phila Pa 1976) Date: 2000-01-15 Impact factor: 3.468
Authors: S Pesenti; J-L Jouve; C Morin; S Wolff; J Sales de Gauzy; A Chalopin; A Ibnoulkhatib; E Polirsztok; A Walter; S Schuller; K Abelin-Genevois; J Leroux; J Lechevallier; R Kabaj; P Mary; S Fuentes; H Parent; C Garin; K Bin; E Peltier; B Blondel; D Chopin Journal: Orthop Traumatol Surg Res Date: 2015-07-17 Impact factor: 2.256