Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
European Spine Journal
Published in: European Spine Journal 2/2016

01-02-2016 | Original Article

Surgical treatment of double thoracic adolescent idiopathic scoliosis with a rigid proximal thoracic curve

Authors: Hideki Sudo, Yuichiro Abe, Kuniyoshi Abumi, Norimasa Iwasaki, Manabu Ito

Published in: European Spine Journal | Issue 2/2016

Login to get access

Abstract

Purpose

There is limited consensus on the optimal surgical strategy for double thoracic adolescent idiopathic scoliosis (AIS). Recent studies have reported that pedicle screw constructs to maximize scoliosis correction cause further thoracic spine lordosis. The objective of this study was to apply a new surgical technique for double thoracic AIS with rigid proximal thoracic (PT) curves and assess its clinical outcomes.

Methods

Twenty one consecutive patients with Lenke 2 AIS and a rigid PT curve (Cobb angle ≥30º on side-bending radiographs, flexibility ≤30 %) treated with the simultaneous double-rod rotation technique (SDRRT) were included. In this technique, a temporary rod is placed at the concave side of the PT curve. Then, distraction force is applied to correct the PT curve, which reforms a sigmoid double thoracic curve into an approximate single thoracic curve. As a result, the PT curve is typically converted from an apex left to an apex right curve before applying the correction rod for PT and main thoracic curve.

Results

All patients were followed for at least 2 years (average 2.7 years). The average main thoracic and PT Cobb angle correction rate at the final follow-up was 74.7 and 58.0 %, respectively. The average preoperative T5–T12 thoracic kyphosis was 9.3°, which improved significantly to 19.0° (p < 0.0001) at the final follow-up. Although 71 % patients had preoperative level shoulders or a positive radiographic shoulder height, all patients had mildly imbalanced or balanced shoulders at the final follow-up. The average preoperative main thoracic apical vertebral rotation angle of 20.7° improved significantly after surgery to 16.4° (p = 0.0046), while the average preoperative total SRS questionnaire score of 3.7 improved significantly to 4.4 (p = 0.0012) at the final follow-up.

Conclusions

Radiographic findings and patient outcomes were satisfactory. Thoracic kyphosis can be maintained or improved, while coronal and axial deformities can be corrected using SDRRT for Lenke 2 AIS with a rigid PT curve.
Literature
1.
Aaro S, Dahlborn M (1981) Estimation of vertebral rotation and the spinal and ribcage deformity in scoliosis by computer tomography. Spine 6:460–467PubMedCrossRef
2.
Cao K, Watanabe K, Kawakami N et al (2014) Selection of lower instrumented vertebra in treating Lenke type 2A adolescent idiopathic scoliosis. Spine 39:E253–E261PubMedCrossRef
3.
Cao K, Watanabe K, Hosogane N et al (2014) Association of postoperative shoulder balance with adding-on in Lenke Type II adolescent idiopathic scoliosis. Spine 39:E705–E712PubMedCrossRef
4.
Di Silvestre M, Lolli F, Bakaloudis G et al (2013) Apical vertebral derotation in the posterior treatment of adolescent idiopathic scoliosis: myth or reality? Eur Spine J 22:313–323PubMedPubMedCentralCrossRef
5.
Geck MJ, Rinella A, Hawthorne D et al (2009) Comparison of surgical treatment in Lenke 5C adolescent idiopathic scoliosis: anterior dual rod versus posterior pedicle fixation surgery: a comparison of two practices. Spine 34:1942–1951PubMedCrossRef
6.
Ito M, Abumi K, Kotani Y et al (2010) Simultaneous double-rod rotation technique in posterior instrumentation surgery for correction of adolescent idiopathic scoliosis. J Neurosurg Spine 12:293–300PubMedCrossRef
7.
Kim YJ, Lenke LG, Kim J et al (2006) Comparative analysis of pedicle screw versus hybrid instrumentation in posterior spinal fusion of adolescent idiopathic scoliosis. Spine 31:291–298PubMedCrossRef
8.
Kuklo TR, Lenke LG, Graham EJ et al (2002) Correlation of radiographic, clinical, and patient assessment of shoulder balance following fusion versus nonfusion of the proximal thoracic curve in adolescent idiopathic scoliosis. Spine 27:2013–2020PubMedCrossRef
9.
Lee CS, Chung SS, Shin SK et al (2011) Changes of upper thoracic curve and shoulder balance in thoracic adolescent idiopathic scoliosis treated by anterior selective thoracic fusion using VATS. J Spinal Disord Tech 24:462–468PubMedCrossRef
10.
Lenke LG, Betz RR, Clements D et al (2002) Curve prevalence of a new classification of operative adolescent idiopathic scoliosis: does classification correlate with treatment? Spine 27:604–611PubMedCrossRef
11.
Lenke LG, Betz RR, Harms J et al (2001) Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis. J Bone Joint Surg Am 83:1169–1181PubMed
12.
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
13.
Li M, Gu S, Ni J et al (2009) Shoulder balance after surgery in patients with Lenke Type 2 scoliosis corrected with the segmental pedicle screw technique. J Neurosurg Spine 10:214–219PubMedCrossRef
14.
Lowenstein JE, Matsumoto H, Vitale MG et al (2007) Coronal and sagittal plane correction in adolescent idiopathic scoliosis: a comparison between all pedicle screw versus hybrid thoracic hook lumbar screw constructs. Spine 32:448–452PubMedCrossRef
15.
Lubicky JP, Hanson JE, Riley EH, Spinal Deformity Study Group (2011) Instrumentation constructs in pediatric patients undergoing deformity correction correlated with scoliosis research society scores. Spine 36:1692–700
16.
Mladenov KV, Vaeterlein C, Stuecker R (2011) Selective posterior thoracic fusion by means of direct vertebral derotation in adolescent idiopathic scoliosis: effects on the sagittal alignment. Eur Spine J 20:1114–1117PubMedPubMedCentralCrossRef
17.
Newton PO, Marks MC, Bastrom TP et al (2013) Surgical treatment of Lenke 1 main thoracic idiopathic scoliosis: results of a prospective, multicenter study. Spine 38:328–338PubMedCrossRef
18.
Newton PO, Yaszay B, Upasani VV et al (2010) Preservation of thoracic kyphosis is critical to maintain lumbar lordosis in the surgical treatment of adolescent idiopathic scoliosis. Spine 35:1365–1370PubMed
19.
Salmingo RA, Tadano S, Abe Y et al (2014) Influence of implant rod curvature on sagittal correction of scoliosis deformity. Spine J 14:1432–1439PubMedCrossRef
20.
Schwab F, Patel A, Ungar B et al (2010) Adult spinal deformity-postoperative standing imbalance: how much can you tolerate? An overview of key parameters in assessing alignment and planning corrective surgery. Spine 35:2224–2231PubMedCrossRef
21.
Sucato DJ, Agrawal S, O’Brien MF et al (2008) Restoration of thoracic kyphosis after operative treatment of adolescent idiopathic scoliosis: a multicenter comparison of three surgical approaches. Spine 33:2630–2636PubMedCrossRef
22.
Sudo H, Ito M, Abe Y et al (2014) Surgical treatment of Lenke 1 thoracic adolescent idiopathic scoliosis with maintenance of kyphosis using the simultaneous double-rod rotation technique. Spine 39:1163–1169PubMedCrossRef
23.
Sudo H, Ito M, Kaneda K et al (2013) Long-term outcomes of anterior dual-rod instrumentation for thoracolumbar and lumbar curves in adolescent idiopathic scoliosis: a twelve to twenty-three-year follow-up study. J Bone Joint Surg Am 95:e49PubMedCrossRef
24.
Sudo H, Ito M, Kaneda K et al (2013) Long-term outcomes of anterior spinal fusion for treating thoracic adolescent idiopathic scoliosis curves: average 15-year follow-up analysis. Spine 38:819–826PubMedCrossRef
25.
Suk SI, Kim WJ, Lee CS et al (2000) Indications of proximal thoracic curve fusion in thoracic adolescent idiopathic scoliosis: recognition and treatment of double thoracic curve pattern in adolescent idiopathic scoliosis treated with segmental instrumentation. Spine 25:2342–2349PubMedCrossRef
Metadata
Title
Surgical treatment of double thoracic adolescent idiopathic scoliosis with a rigid proximal thoracic curve
Authors
Hideki Sudo
Yuichiro Abe
Kuniyoshi Abumi
Norimasa Iwasaki
Manabu Ito
Publication date
01-02-2016
Publisher
Springer Berlin Heidelberg
Published in
European Spine Journal / Issue 2/2016
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-015-4139-z

Other articles of this Issue 2/2016

European Spine Journal 2/2016 Go to the issue

Original Article

The validity and reliability of “Spinal Mouse” assessment of spinal curvatures in the frontal plane in pediatric adolescent idiopathic thoraco-lumbar curves

Original Article

Characteristics of lumbar spondylolysis in elementary school age children

Original Article

Functional consequences and health-care seeking behaviour for recurrent non-specific low back pain in Zimbabwean adolescents: a cross-sectional study

Original Article

Accumulation of psychosocial and lifestyle factors and risk of low back pain in adolescence: a cohort study

Original Article

Clinically orientated classification incorporating shoulder balance for the surgical treatment of adolescent idiopathic scoliosis

Original Article

Vertebral coplanar alignment technique: a surgical option for correction of adult thoracic idiopathic scoliosis