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Spine (Phila Pa 1976). 2009 Apr 15;34(8):852-7; discussion 858. doi: 10.1097/BRS.0b013e31818e5962.

Pedicle screw instrumentation for adult idiopathic scoliosis: an improvement over hook/hybrid fixation.

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  • 1Washington University Medical Center, St. Louis, MO 63110, USA.

Abstract

STUDY DESIGN:

A matched cohort comparison of adult idiopathic scoliosis (AdIS) patients treated with all pedicle screw constructs compared to hook/hybrid constructs.

OBJECTIVE:

To compare clinical and radiographic results of AdIS treatment using all pedicle screw constructs versus hook/hybrid constructs.

SUMMARY OF BACKGROUND DATA:

Pedicle screw instrumentation has demonstrated excellent clinical efficacy in the treatment of pediatric spinal deformity. No prior reports have compared the outcomes of pedicle screw only constructs to hook/hybrid constructs in the treatment of AdIS.

METHODS:

We analyzed 34 consecutive patients undergoing posterior-only correction for AdIS, using pedicle screw instrumentation at minimum 2-year follow-up. Thirty-four matching patients (11 with anterior releases) were selected from a cohort of 58 patients treated with hook/hybrid constructs based on similar age, curve type, magnitude, and fusion levels.

RESULTS:

Significantly greater curve correction was seen in the pedicle screw compared to the hook/hybrid group (56 vs. 40%, P < 0.01). Coronal and sagittal imbalance were equivalent between the groups (P = 0.91 and 0.23, respectively). Thoracic kyphosis (T5-T12) was maintained in the pedicle screw patients but significantly increased in the hybrid/hook patients over time (P < 0.05). Scoliosis Research Society outcome scores significantly improved in both groups. Blood loss was equivalent but operative time was longer in the hook/hybrid patients.No pedicle screw patients were revised for instrumentation complications with 1 lumbosacral nonunion revised at 5 years postoperative (3% revision rate). Eight of 58 patients among the hook/hybrid cohort underwent 9 revisions for instrumentation failure (n = 3) or nonunion (n = 6) (14% revision rate; P = 0.04).

CONCLUSION:

Pedicle screw correction of AdIS is safe and effective. Compared to hook/hybrid constructs, these patients displayed significantly improved correction of the major curve (even in the absence of anterior releases), maintenance of thoracic kyphosis, and a lower revision rate. Similar SRS scores and blood loss were noted. The hook/hybrid patients had significantly longer operative times. The use of BMP-2 in 7 patients and TLIF/ALIF also in 7 of the pedicle screw patients may have decreased the need for revision surgery up to the latest follow-up.

PMID:
19365256
[PubMed - indexed for MEDLINE]
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