Treatment of adolescent idiopathic scoliosis with global (ROD) derotation maneuver using pedicle screws

Introduction: Adolescent idiopathic scoliosis is a three dimensional deformity. For the treatment of deformity, nature of deformity should be well understood and treatment strategy has to be directed to the coronal, sagittal and axial components of deformity. Global Derotation (GD) maneuver is based on simple rod derotation from concave side aiming to correct the deformity on coronal, sagittal and axial profile. In this report we reviewed AIS surgery results treated by global derotation maneuver with all pedicle screw instrumentation.Material& Methods: Between 2003 and 2011, 253 patients had been operated using GD technique.80 of 253 patients was included to our study. The patients routinely evaluated with preoperative-postoperative and last follow up standing ortho-x-rays. Coronal and sagittal profile parameters measured on x-rays with digital software using Cobb method. Rotational component of the deformity was measured according to Nash-Moe method at the apical vertebra.Results: 80 patients (71 female ; 9 male)had been followed up average 19,8 (7-37) months. Patients age average were 15,1(12-21) at operation date. Coronal cobb angle measure in thoracic curves preoperative were 48,9° decreased to mean 3,2° postoperatively. The mean coronal thoracolumbar curve were 45,8° preoperatively and decreased to mean 2°. Apical vertebra rotation measure regressed to mean 0,68 (0-1). Thoracic kyphosis showed downward tendency from mean 37,8° to mean 27,8°.Conclusion: Rod derotation technique enable to correct coronal and axial profile. Coronal Cobb angle improvement seen obviously with correction of axial profile rotation. Sagittal hypokyphotic effect of GD should be kept in mind

Lenke 5 curves. Is thoracic fusion really necessary?

Objective: The recommended surgery for Lenke type 5 curve is only the fusion of structural curve (SF: Selective fusion). However, some surgeons prefer to fuse both the thoracolumbar and lumbar (TL/L) curve and the non-structural thoracic (T) curve (NSF: Non-selective fusion). There is a lack of data with regard to the mid-to-long-term outcomes of the SF and NSF. In this study, it was aimed to compare SF and NSF in terms of TL/L and T curve correction rates and the prognosis of the corrected curves. Materials and Methods: A retrospective study of AIS patients treated at a single institution was conducted. A total of 59 patients (55F/M4) were included in the study. Preoperative, early postoperative, and last follow-up TL/L Cobb and T Cobb angles were measured with software. SF and NSF correction rate comparison was done using the Mann-Whitney U test. Results: Overall, 35 patients underwent NSF while 24 patients underwent SF. The mean follow-up duration was 43±18.05 months (54-98). Early T Cobb correction rate was 69% in group 1 (SF) and 79% group 2 (NSF); however, this difference was not statistically significant when the groups were compared (p=0.71138). The last follow-up T Cobb correction rates for group 1 and group 2 were 66% and 79%, respectively (p=0.5485). Early TL/ L Cobb correction rate was 78% in group 1 and it was 79% in group 2 (p=0.8493). Last follow-up TL/L Cobb follow-up correction rates for groups were 79% and 76%, respectively (p=0.9203).Conclusion: This study concluded that SF had favorable outcomes without loss of correction for the patients with Lenke type 5C AIS in the mid-to-long-term.Keywords: Lenke type 5C AIS, selective fusion, non-selective fusion, loss of correction, prognosi