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Open Access 01-02-2015 | Original Clinical Article

Spinal deformity progression after posterior segmental instrumentation and fusion for idiopathic scoliosis

Authors: Vidyadhar V. Upasani, Daniel J. Hedequist, M. Timothy Hresko, Lawrence I. Karlin, John B. Emans, Michael P. Glotzbecker

Published in: Journal of Children's Orthopaedics | Issue 1/2015

Abstract

Study design

Retrospective chart and radiographic review.

Purpose

To assess the incidence of and variables associated with spinal deformity progression after posterior segmental instrumentation and fusion at a single institution. Progression of the scoliotic deformity after posterior instrumented spinal fusion has been described. Recent studies have concluded that segmental pedicle screw constructs are better able to control deformity progression.

Methods

Retrospective review of a consecutive series of idiopathic scoliosis patients (n = 89) with major thoracic curves (Lenke types 1–4) treated with posterior segmental instrumentation and fusion. Deformity progression was defined as a 10° increase in Cobb angle between the first-erect and 2-year post-operative radiographs. Clinical and radiographic data between the two cohorts (deformity progression versus stable) were analyzed to determine the variables associated with deformity progression.

Results

Patients in the deformity progression group (n = 13) tended to be younger (median 13.7 vs. 14.7 years) and experienced a significant change in height (p = 0.01) during the post-operative period compared to the stable group (n = 76). At 2-years post-op, the patients in the deformity progression group had experienced a significantly greater change in upper instrumented vertebra (UIV) angulation, lower instrumented vertebra (LIV) angulation, and apical vertebral translation (AVT). Two-year post-op Scoliosis Research Society questionnaire (SRS-22) scores in the appearance domain were also significantly worse in the deformity progression group. Patients in the deformity progression group had a significantly greater difference between the lowest instrumented vertebra and stable vertebra compared to patients in the stable group (p = 0.001).

Conclusions

Deformity progression after posterior spinal fusion does occur after modern segmental instrumentation. Segmental pedicle screw constructs do not prevent deformity progression. Skeletally immature patients with a significant growth potential are at the highest risk for deformity progression. In immature patients, extending the fusion distally to the stable vertebra may minimize deformity progression.

Level of evidence

Level III.

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Title: Spinal deformity progression after posterior segmental instrumentation and fusion for idiopathic scoliosis
Authors: Vidyadhar V. Upasani
Daniel J. Hedequist
M. Timothy Hresko
Lawrence I. Karlin
John B. Emans
Michael P. Glotzbecker
Publication date: 01-02-2015
Publisher: Springer Berlin Heidelberg
Published in: Journal of Children's Orthopaedics / Issue 1/2015
Print ISSN: 1863-2521
Electronic ISSN: 1863-2548
DOI: https://doi.org/10.1007/s11832-015-0632-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Spinal deformity progression after posterior segmental instrumentation and fusion for idiopathic scoliosis

Abstract

Study design

Purpose

Methods

Results

Conclusions

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Study design

Purpose

Methods

Results

Conclusions

Level of evidence

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