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European Spine Journal

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01-01-2012 | Review Article

Pedicle screw instrumentation in adolescent idiopathic scoliosis (AIS)

Authors: Se-Il Suk, Jin-Hyok Kim, Sung-Soo Kim, Dong-Ju Lim

Published in: European Spine Journal | Issue 1/2012

Abstract

Introduction

Pedicle screw instrumentation in AIS has advantages of rigid fixation, improved deformity correction and a shorter fusion, but needs an exacting technique.

Materials and methods

The author has been using the K-wire method with intraoperative single PA and lateral radiographs, because it is safe, accurate and fast. Pedicle screws are inserted in every segment on the correction side (thoracic concave) and every 2–3 on the supportive side (thoracic convex). After an over-bent rod is inserted on the corrective side, the rod is rotated 90° counterclockwise. This maneuver corrects the coronal and sagittal curves. Then the vertebra is derotated by direct vertebral rotation (DVR) correcting the rotational deformity. The direction of DVR should be opposite to that of the vertebral rotation. A rigid rod has to be used to prevent the rod from straightening out during the rod derotation and DVR. The ideal classification of AIS should address all curve patterns, predicts accurate fusion extent and have good inter/intraobserver reliability. The Suk classification matches the ideal classification is simple and memorable, and has only four structural curve patterns; single thoracic, double thoracic, double major and thoracolumbar/lumbar. Each curve has two types, A and B. When using pedicle screws in thoracic AIS, curves are usually fused from upper neutral to lower neutral vertebra. Identification of the end vertebra and the neutral vertebra is important in deciding the fusion levels and the direction of DVR. In lumbar AIS, fusion is performed from upper neutral vertebra to L3 or L4 depending on its curve types.

Conclusions

Rod derotation and DVR using pedicle screw instrumentation give true three dimensional deformity correction in the treatment of AIS. Suk classification with these methods predicts exact fusion extent and is easy to understand and remember.

Harrington PR (1962) Treatment of scoliosis. J Bone Joint Surg Am 44:591–610PubMed

Goldstein LA (1969) Treatment of idiopathic scoliosis by Harrington instrumentation and fusion with fresh autogenous iliac bone grafts. J Bone Joint Surg Am 51:209–222PubMed

King H, Moe JH, Bradford DS et al (1983) The selection of fusion levels in thoracic idiopathic scoliosis. J Bone Joint Surg Am 65:1302–1313PubMed

Suk SI, Lee CK, Kim WJ et al (1995) Segmental pedicle screw fixation in the treatment of thoracic idiopathic scoliosis. Spine 20:1399–1405PubMed

Suk SI, Kim WJ, Lee SM et al (2001) Thoracic pedicle screw fixation in spinal deformities: are they really safe? Spine 26:2049–2057PubMedCrossRef

Boucher HH (1959) A method of spinal fusion. J Bone Joint Surg Br 41:248–259PubMed

Roy-Camille R, Saillant G, Mazel C (1986) Internal fixation of the lumbar spine with pedicle screw plating. Clin Orthop 203:7–17PubMed

Cotrel Y, Dubousset J, Guillaumat M (1988) New universal instrumentation in spinal surgery. Clin Orthop 227:10–23PubMed

Suk SI, Lee CK, Min HJ et al (1994) Comparison of Cotrel-Dubousset pedicle screws and hooks in the treatment of idiopathic scoliosis. Int Orthop 18:341–346PubMedCrossRef

10.

Liljenqvist UR, Halm HF, Link TM (1997) Pedicle screw instrumentation of the thoracic spine in idiopathic scoliosis. Spine 22:2239–2245PubMedCrossRef

11.

Esses SI, Sachs BL, Dreyzin V (1993) Complications associated with the technique of pedicle screw fixation: a selected survey of ABS members. Spine 18:2231–2239PubMedCrossRef

12.

Brown CA, Lenke LG, Bridwell KH et al (1998) Complications of pedicle thoracolumbar and lumbar pedicle screws. Spine 23:1566–1571PubMedCrossRef

13.

Lonstein JE, Denis F, Perra JH et al (1999) Complications associated with pedicle screws. J Bone Joint Surg Am 81:1519–1528PubMed

14.

Lenke LG, Edwards CC II, Bridwell KH (2003) The Lenke classification adolescent idiopathic scoliosis: how it organizes curve patterns as a template to perform selective fusions of the spine. Spine 28:S199–S207PubMedCrossRef

15.

Kim YJ, Lenke LG, Bridwell KH et al (2004) Free hand pedicle screw placement in the thoracic spine: is it safe? Spine 29:333–342

16.

Wong CC, Ting F, Wong B et al (2005) Accuracy of the funnel technique of thoracic pedicle in scoliosis surgery––an evaluation by CT-scans. Med J Malaysia 60S:35–40

17.

Di Silvestre M, Parisini P, Lolli F et al (2007) Complications of thoracic pedicle screws in scoliosis treatment. Spine 32:1655–1661

18.

Suk SI, Kim WJ (1998) Pedicle screw fixation for thoracic scoliosis. In: Brown CW (ed) Spinal instrumentation techniques. Scoliosis Research Society, Rosemont

19.

Suk SI, Cha SI, Lee CK et al (1995) A study on the pullout strength of pedicle screws in relation to the size of the drill holes and inserted screws. Presented at the 30th annual meeting of the scoliosis research society, Asheville, NC

20.

Zindrick MR, Wiltse LL, Doomik A et al (1987) Analysis of the morphometric characteristics of the thoracic and lumbar pedicles. Spine 12:160–166PubMedCrossRef

21.

Misenhimer GR, Peek RD, Wiltse LL et al (1989) Anatomic analysis of pedicle cortical and cancellous diameter as related to screw size. Spine 14:367PubMedCrossRef

22.

Suk SI, Lee JH (1994) A study of the diameter and change of the vertebral pedicle after screw insertion. Presented at third intermeeting SIROT, Boston, Massachusetts

23.

Bridwell KH, McAllister JW, Betz RR et al (1991) Coronal decompensation produced by Cotrel–Dubousset “derotation” maneuver for idiopathic right thoracic scoliosis. Spine 16:769–777PubMedCrossRef

24.

Labelle H, Dansereau J, Bellefleur C et al (1995) Preoperative three-dimensional correction of idiopathic scoliosis with the Cotrel-Dubousset procedure. Spine 20:1406–1409PubMed

25.

Suk SI, Kim WJ, Kim JH et al (1999) Restoration of thoracic kyphosis in the hypokyphotic spine: a comparison between multiple-hook and segmental pedicle screw fixation in adolescent idiopathic scoliosis. J Spinal Disord 12:489–495PubMedCrossRef

26.

Lee SM, Suk SI, Chung ER (2004) Direct vertebral rotation: A new technique of three-dimensionaldeformity correction with segmental pedicle screw fixation in adolescent idiopathic scoliosis. Spine 29:343–349

27.

Lenke LG, Betz RR, Bridwell KH et al (1999) Spontaneous lumbar curve coronal correction after selective anterior or posterior thoracic fusion in adolescent idiopathic scoliosis. Spine 24:1663–1671PubMedCrossRef

28.

Shufflebarger HL, Clark CE (1990) Fusion levels and hook patterns in thoracic scoliosis with Cotrel–Dubousset instrumentation. Spine 15:916–920PubMedCrossRef

29.

Marguilis JY, Floman Y, Robin GC et al (1998) An algorithm for selection of instrumentation levels in scoliosis. Eur Spine J 7:88–94CrossRef

30.

Suk SI, Lee SM, Chung ER et al (2003) Determination of distal fusion level with segmental pedicle screw fixation in single thoracic idiopathic scoliosis. Spine 28:484–491PubMed

31.

Arlet V, Marchesi D, Papin P et al (2000) Decompensation following scoliosis surgery: treatment by decreasing the correction of the main thoracic curve or “letting the spine go”. Eur Spine J 9:156–160PubMedCrossRef

32.

Lee CK, Denis F, Winter RB et al (1993) Analysis of upper thoracic curve in surgically treated idiopathic scoliosis: a new concept of double thoracic curve pattern. Spine 18:1599–1608PubMedCrossRef

33.

Lenke LG, Bridwell KH, O’Brien MF et al (1994) Recognition and treatment of the proximal thoracic curve in adolescent idiopathic scoliosis treated with Cotrel–Dubousset instrumentation. Spine 19:1589–1597PubMedCrossRef

34.

Winter RB, Denis F (1994) The King type V curve pattern. Its analysis and surgical treatment. Orthop Clin North Am 25:353–362PubMed

35.

Suk SI, Kim WJ, Lee CS et al (2000) Indications of proximal thoracic curve fusion in thoracic adolescent idiopathic scoliosis. Spine 25:2342–2349PubMedCrossRef

36.

Suk SI, Lee CK, Chung SS (1994) Comparison of Zielke ventral derotation system and Cotrel-Dubousset instrumentation in the treatment of idiopathic lumbar and thoracolumbar scoliosis. Spine 19:419–429PubMedCrossRef

Title: Pedicle screw instrumentation in adolescent idiopathic scoliosis (AIS)
Authors: Se-Il Suk
Jin-Hyok Kim
Sung-Soo Kim
Dong-Ju Lim
Publication date: 01-01-2012
Publisher: Springer-Verlag
Published in: European Spine Journal / Issue 1/2012
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-011-1986-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Pedicle screw instrumentation in adolescent idiopathic scoliosis (AIS)

Abstract

Introduction

Materials and methods

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Materials and methods

Conclusions

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