J Korean Soc Spine Surg.  2005 Dec;12(4):289-298.

Selective Thoracic Fusion with Segmental Pedicle Screw Fixation for the Treatment of Thoracic Idiopathic Scoliosis: More than Five Year's Follow-Up

• Suk SI
• Kim JH
• Kim SS
• Lee JJ
• Han YT
• Choi EO

Abstract

STUDY DESIGN: This is a retrospective study.
OBJECTIVES
We wanted to evaluate the outcomes of selective thoracic fusion with segmental pedicle screw fixation for treating thoracic idiopathic scoliosis with a minimum 5-year follow-up. SUMMARY OF THE LITERATURE REVIEW: Segmental pedicle screw fixation has been proven to achieve true segmental control and greater correction of scoliosis in both the coronal and sagittal planes. However, there is no long-term study of selective thoracic fusion with segmental pedicle screw fixation for treating thoracic idiopathic scoliosis.
MATERIALS AND METHODS
We analyzed 203 thoracic idiopathic scoliosis patients (236 thoracic curves) who underwent selective thoracic fusion with segmental pedicle screw fixation. The mean patient age at the time of operation was 13.8 years (range: 8.9~18 years).
RESULTS
The preoperative thoracic curve of 51+/-12 degrees was corrected to 16+/-7 degrees(69% correction with 3% loss of correction) at the most recent follow-up. The non-instrumented lumbar curve of 30+/-10 degrees was corrected to 10+/-8 degrees(66% correction with 5% loss of correction) at the most recent follow-up. The preoperative thoracic kyphosis of 18+/-11 degrees and the lumbar lordosis of 43+/-10 degrees were improved to 23+/-8 degrees and 46+/-9 degrees, respectively, at the most recent follow-up. There was no junctional kyphosis at the most recent follow-up. Coronal decompensation at the most recent follow-up occurred in 10 patients. Postoperative adding-on occurred in 17 patients who were fused two levels short of the neutral vertebra. Of the 2867 thoracic pedicle screws inserted at the thoracic level, 43 screws were found to be malpositioned (1.5%), but they did not cause neurologic complications or adversely affect the long-term results.
CONCLUSIONS
Selective thoracic fusion with segmental pedicle screw fixation for treating thoracic idiopathic scoliosis had satisfactory radiographic and clinical outcomes after surgery, and the outcomes were well-maintained for a minimum of 5 years follow-up. It is a safe and effective method for preserving segments of lumbar motion as well as for the restoration and maintenance of both the coronal and sagittal alignments.

Keyword

Thoracic idiopathic scoliosis; Selective thoracic fusion; Segmental fixation; Pedicle screw

MeSH Terms

Animals
Follow-Up Studies*
Humans
Kyphosis
Lordosis
Retrospective Studies
Scoliosis*
Spine

Figure

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  Fig. 1. A 13- year 3-month-old girl with single thoracic curve. (A) Preoperative anteroposterior radiograph shows 68° main thoracic curve and 49° lumbar curve. (B) Preoperative lateral radiograph. (C) Anteroposterior radiograph taken 1 month after surgery. The main thoracic curve was corrected to 20°, and the lumbar curve was spontaneously corrected to 20°. (D) Lateral radiograph taken 1 month after surgery. Thoracic kyphosis was improved also. (E, F) Anteroposterior and lateral radiographs taken 6 years and 3 months after surgery. Coronal and sagittal alignments were well maintained during the follow-up.

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  Fig. 2. A 11-year-old girl with double thoracic curve. (A) Preoperative anteroposterior radiograph shows 72° main thoracic curve and 49° proximal thoracic curve. (B) Preoperative lateral radiograph. (C) Anteroposterior radiograph taken 1 month after surgery. The main thoracic curve was corrected to 17°, and the proximal thoracic curve was corrected to 19°. (D) Lateral radiograph taken 1 month after surgery. Thoracic kyphosis was improved also. (E, F) Anteroposterior and lateral radiographs taken 5 years and 3months after surgery. Coronal and sagittal alignments were well maintained during the follow-up.

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