Very long-term clinical and radiographic outcomes after posterior spinal fusion with pedicular screws for thoracic adole
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Very long‑term clinical and radiographic outcomes after posterior spinal fusion with pedicular screws for thoracic adolescent idiopathic scoliosis Alice Darnis1 · Pierre Grobost1 · Pierre Roussouly1 Received: 21 January 2020 / Accepted: 21 September 2020 © Scoliosis Research Society 2020
Abstract Purpose To report radiographic and functional outcomes, with an average follow-up of 20 years, of adolescents treated surgically for thoracic idiopathic scoliosis by hybrid construct using only pedicular screws for the distal fixation. Methods We retrospectively reviewed 109 patients. Radiographic data were evaluated on fullspine radiographs (Cobb angle, pelvic incidence, sacral slope, pelvic tilt, thoracic kyphosis, lumbar lordosis). Clinical data were evaluated with ODI, SF-12, SRS-30 and Analog Pain Scale. Disc height and listhesis below the arthrodesis were measured. Results We analyzed 90 women and 19 men with a mean age of 16.9 y.o. at surgery. Radiographic data were assessed for 46 patients after 17.4 years. Mean preoperative Cobb angle was 58°, mean correction 40.1% with 5.3° of loss at final FU. Lumbar lordosis and thoracic kyphosis increased significantly at last FU. Degenerative changes below the arthrodesis were reported in 5 cases. Clinical data were assessed for 42 patients after 19.9 years: SRS-30 3.8; ODI 12.3%; SF-12 PCS 48.6 and MCS 46. Low back pain was reported in 69% of cases with low intensity (3.1). The lowest instrumented vertebrae did not influence significantly the functional outcome. Conclusions The correction of thoracic AIS with lumbar or thoracolumbar pedicle screw instrumentation provides good radiological and clinical outcomes at very long term. The reduction in the coronal plane is stable; the HRQoL is quite as good as the general population. The degenerative evolution below remain relatively rare, therefore global sagittal balance is not modified. Keywords Thoracic adolescent idiopathic scoliosis · Pedicular screws · Long-term outcomes · Quality of life · Sagittal alignment
Introduction Very long-term follow-up of Adolescent Idiopathic Scoliosis (AIS) previously treated surgically was analyzed in few studies in the litterature [1–4]. Due to the length of followup, these studies focused on disappeared today techniques using exclusively hooks such as Harrington or later CotrelDubousset instrumentation (CDI). Thoracic deformity accounts for the majority of AIS cases and the pedicle screws construct for surgical reduction * Alice Darnis [email protected] 1
and fusion is the preferred instrumentation technique even if there is no clear consensus about it. Pedicle screws seem to provide a better coronal, sagittal, and rotational correction than hook constructs [5–7]. To our knowledge, there is no published study with more than 15 years’ follow-up reporting radiographic and clinical results of pedicle screws construct for thoracic AIS. We proposed a study of thoracic AIS previously treated by hybrid construct with at least two levels of pedicular screws for the dista
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