The Use of High-Density Pedicle Screw Construct with Direct Vertebral Derotation of the Lowest Instrumented Vertebra in Selective Thoracic Fusion for Adolescent Idiopathic Scoliosis: Comparison of Two Surgical Strategies
Study Design: This study was a retrospective case series.Purpose: This study was designed to determine whether direct vertebral rotation (DVR) of the lowest instrumented vertebra (LIV) using a high-density (HD) construct can reduce fusion segments without increasing adverse outcomes in selective tho...
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| Vydané v: | Asian spine journal Ročník 17; číslo 2; s. 338 - 346 |
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| Hlavní autori: | , , , , , |
| Médium: | Journal Article |
| Jazyk: | English |
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Korea (South)
Korean Society of Spine Surgery
01.04.2023
Korean Spine Society 대한척추외과학회 |
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| ISSN: | 1976-1902, 1976-7846 |
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| Abstract | Study Design: This study was a retrospective case series.Purpose: This study was designed to determine whether direct vertebral rotation (DVR) of the lowest instrumented vertebra (LIV) using a high-density (HD) construct can reduce fusion segments without increasing adverse outcomes in selective thoracic fusion (STF) for adolescent idiopathic scoliosis (AIS).Overview of Literature: LIV DVR is used to maximize spontaneous lumbar curve correction and reduce adverse outcomes during STF for AIS. However, evidence is limited on whether LIV DVR can allow a proximally located LIV and reduce fusion segments without increasing adverse outcomes.Methods: We reviewed consecutive patients with Lenke 1 AIS who underwent STF from 2000 to 2017. The patients were divided into two groups based on the surgical strategy used: low-density (LD) construct without DVR of the LIV (LD group) versus HD construct with DVR of the LIV (HD group). We collected data on the patient’s demographic characteristics, skeletal maturity, operative data, and measured radiological parameters in the preoperative and final follow-up radiographs. The occurrence of adding-on (AO) and coronal decompensation was also determined.Results: In this study, 72 patients (five males and 67 females) with a mean age of 14.1±2.3 years were included. No significant differences in the demographics, skeletal maturity, and Lenke type distribution were observed between the two groups; however, the follow-up duration was significantly longer in the LD group (64.3±25.7 months vs. 40.7±22.2 months, p <0.001). The HD group had significantly shorter fusion segments (7.1±1.3 vs. 8.5±1.2, p <0.001) and a more proximal LIV level (12.1±0.9 vs. 12.7±1.0, p =0.009). In the radiological measurements, the improvement of LIV+1 rotation (Nash–Moe scale) was significantly larger in the HD group (0.53±0.51 vs. 0.21±0.41, p =0.008). AO and decompensation occurred in 7 (9.7%) and 4 (5.6%) patients in the HD and LD groups, respectively, without any significant difference between the two groups.Conclusions: In this study, the HD group had a significantly shorter fusion level and a more proximal LIV than the LD group; however, the two groups had similar curve correction and adverse radiological outcome rates. |
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| AbstractList | Study Design This study was a retrospective case series. Purpose This study was designed to determine whether direct vertebral rotation (DVR) of the lowest instrumented vertebra (LIV) using a high-density (HD) construct can reduce fusion segments without increasing adverse outcomes in selective thoracic fusion (STF) for adolescent idiopathic scoliosis (AIS). Overview of Literature LIV DVR is used to maximize spontaneous lumbar curve correction and reduce adverse outcomes during STF for AIS. However, evidence is limited on whether LIV DVR can allow a proximally located LIV and reduce fusion segments without increasing adverse outcomes. Methods We reviewed consecutive patients with Lenke 1 AIS who underwent STF from 2000 to 2017. The patients were divided into two groups based on the surgical strategy used: low-density (LD) construct without DVR of the LIV (LD group) versus HD construct with DVR of the LIV (HD group). We collected data on the patient’s demographic characteristics, skeletal maturity, operative data, and measured radiological parameters in the preoperative and final follow-up radiographs. The occurrence of adding-on (AO) and coronal decompensation was also determined. Results In this study, 72 patients (five males and 67 females) with a mean age of 14.1±2.3 years were included. No significant differences in the demographics, skeletal maturity, and Lenke type distribution were observed between the two groups; however, the follow-up duration was significantly longer in the LD group (64.3±25.7 months vs. 40.7±22.2 months, p<0.001). The HD group had significantly shorter fusion segments (7.1±1.3 vs. 8.5±1.2, p<0.001) and a more proximal LIV level (12.1±0.9 vs. 12.7±1.0, p=0.009). In the radiological measurements, the improvement of LIV+1 rotation (Nash–Moe scale) was significantly larger in the HD group (0.53±0.51 vs. 0.21±0.41, p=0.008). AO and decompensation occurred in 7 (9.7%) and 4 (5.6%) patients in the HD and LD groups, respectively, without any significant difference between the two groups. Conclusions In this study, the HD group had a significantly shorter fusion level and a more proximal LIV than the LD group; however, the two groups had similar curve correction and adverse radiological outcome rates. This study was a retrospective case series. This study was designed to determine whether direct vertebral rotation (DVR) of the lowest instrumented vertebra (LIV) using a high-density (HD) construct can reduce fusion segments without increasing adverse outcomes in selective thoracic fusion (STF) for adolescent idiopathic scoliosis (AIS). LIV DVR is used to maximize spontaneous lumbar curve correction and reduce adverse outcomes during STF for AIS. However, evidence is limited on whether LIV DVR can allow a proximally located LIV and reduce fusion segments without increasing adverse outcomes. We reviewed consecutive patients with Lenke 1 AIS who underwent STF from 2000 to 2017. The patients were divided into two groups based on the surgical strategy used: low-density (LD) construct without DVR of the LIV (LD group) versus HD construct with DVR of the LIV (HD group). We collected data on the patient's demographic characteristics, skeletal maturity, operative data, and measured radiological parameters in the preoperative and final follow-up radiographs. The occurrence of adding-on (AO) and coronal decompensation was also determined. In this study, 72 patients (five males and 67 females) with a mean age of 14.1±2.3 years were included. No significant differences in the demographics, skeletal maturity, and Lenke type distribution were observed between the two groups; however, the follow-up duration was significantly longer in the LD group (64.3±25.7 months vs. 40.7±22.2 months, p <0.001). The HD group had significantly shorter fusion segments (7.1±1.3 vs. 8.5±1.2, p <0.001) and a more proximal LIV level (12.1±0.9 vs. 12.7±1.0, p =0.009). In the radiological measurements, the improvement of LIV+1 rotation (Nash-Moe scale) was significantly larger in the HD group (0.53±0.51 vs. 0.21±0.41, p =0.008). AO and decompensation occurred in 7 (9.7%) and 4 (5.6%) patients in the HD and LD groups, respectively, without any significant difference between the two groups. In this study, the HD group had a significantly shorter fusion level and a more proximal LIV than the LD group; however, the two groups had similar curve correction and adverse radiological outcome rates. Study Design: This study was a retrospective case series.Purpose: This study was designed to determine whether direct vertebral rotation (DVR) of the lowest instrumented vertebra (LIV) using a high-density (HD) construct can reduce fusion segments without increasing adverse outcomes in selective thoracic fusion (STF) for adolescent idiopathic scoliosis (AIS).Overview of Literature: LIV DVR is used to maximize spontaneous lumbar curve correction and reduce adverse outcomes during STF for AIS. However, evidence is limited on whether LIV DVR can allow a proximally located LIV and reduce fusion segments without increasing adverse outcomes.Methods: We reviewed consecutive patients with Lenke 1 AIS who underwent STF from 2000 to 2017. The patients were divided into two groups based on the surgical strategy used: low-density (LD) construct without DVR of the LIV (LD group) versus HD construct with DVR of the LIV (HD group). We collected data on the patient’s demographic characteristics, skeletal maturity, operative data, and measured radiological parameters in the preoperative and final follow-up radiographs. The occurrence of adding-on (AO) and coronal decompensation was also determined.Results: In this study, 72 patients (five males and 67 females) with a mean age of 14.1±2.3 years were included. No significant differences in the demographics, skeletal maturity, and Lenke type distribution were observed between the two groups; however, the follow-up duration was significantly longer in the LD group (64.3±25.7 months vs. 40.7±22.2 months, p <0.001). The HD group had significantly shorter fusion segments (7.1±1.3 vs. 8.5±1.2, p <0.001) and a more proximal LIV level (12.1±0.9 vs. 12.7±1.0, p =0.009). In the radiological measurements, the improvement of LIV+1 rotation (Nash–Moe scale) was significantly larger in the HD group (0.53±0.51 vs. 0.21±0.41, p =0.008). AO and decompensation occurred in 7 (9.7%) and 4 (5.6%) patients in the HD and LD groups, respectively, without any significant difference between the two groups.Conclusions: In this study, the HD group had a significantly shorter fusion level and a more proximal LIV than the LD group; however, the two groups had similar curve correction and adverse radiological outcome rates. KCI Citation Count: 0 This study was a retrospective case series.STUDY DESIGNThis study was a retrospective case series.This study was designed to determine whether direct vertebral rotation (DVR) of the lowest instrumented vertebra (LIV) using a high-density (HD) construct can reduce fusion segments without increasing adverse outcomes in selective thoracic fusion (STF) for adolescent idiopathic scoliosis (AIS).PURPOSEThis study was designed to determine whether direct vertebral rotation (DVR) of the lowest instrumented vertebra (LIV) using a high-density (HD) construct can reduce fusion segments without increasing adverse outcomes in selective thoracic fusion (STF) for adolescent idiopathic scoliosis (AIS).LIV DVR is used to maximize spontaneous lumbar curve correction and reduce adverse outcomes during STF for AIS. However, evidence is limited on whether LIV DVR can allow a proximally located LIV and reduce fusion segments without increasing adverse outcomes.OVERVIEW OF LITERATURELIV DVR is used to maximize spontaneous lumbar curve correction and reduce adverse outcomes during STF for AIS. However, evidence is limited on whether LIV DVR can allow a proximally located LIV and reduce fusion segments without increasing adverse outcomes.We reviewed consecutive patients with Lenke 1 AIS who underwent STF from 2000 to 2017. The patients were divided into two groups based on the surgical strategy used: low-density (LD) construct without DVR of the LIV (LD group) versus HD construct with DVR of the LIV (HD group). We collected data on the patient's demographic characteristics, skeletal maturity, operative data, and measured radiological parameters in the preoperative and final follow-up radiographs. The occurrence of adding-on (AO) and coronal decompensation was also determined.METHODSWe reviewed consecutive patients with Lenke 1 AIS who underwent STF from 2000 to 2017. The patients were divided into two groups based on the surgical strategy used: low-density (LD) construct without DVR of the LIV (LD group) versus HD construct with DVR of the LIV (HD group). We collected data on the patient's demographic characteristics, skeletal maturity, operative data, and measured radiological parameters in the preoperative and final follow-up radiographs. The occurrence of adding-on (AO) and coronal decompensation was also determined.In this study, 72 patients (five males and 67 females) with a mean age of 14.1±2.3 years were included. No significant differences in the demographics, skeletal maturity, and Lenke type distribution were observed between the two groups; however, the follow-up duration was significantly longer in the LD group (64.3±25.7 months vs. 40.7±22.2 months, p <0.001). The HD group had significantly shorter fusion segments (7.1±1.3 vs. 8.5±1.2, p <0.001) and a more proximal LIV level (12.1±0.9 vs. 12.7±1.0, p =0.009). In the radiological measurements, the improvement of LIV+1 rotation (Nash-Moe scale) was significantly larger in the HD group (0.53±0.51 vs. 0.21±0.41, p =0.008). AO and decompensation occurred in 7 (9.7%) and 4 (5.6%) patients in the HD and LD groups, respectively, without any significant difference between the two groups.RESULTSIn this study, 72 patients (five males and 67 females) with a mean age of 14.1±2.3 years were included. No significant differences in the demographics, skeletal maturity, and Lenke type distribution were observed between the two groups; however, the follow-up duration was significantly longer in the LD group (64.3±25.7 months vs. 40.7±22.2 months, p <0.001). The HD group had significantly shorter fusion segments (7.1±1.3 vs. 8.5±1.2, p <0.001) and a more proximal LIV level (12.1±0.9 vs. 12.7±1.0, p =0.009). In the radiological measurements, the improvement of LIV+1 rotation (Nash-Moe scale) was significantly larger in the HD group (0.53±0.51 vs. 0.21±0.41, p =0.008). AO and decompensation occurred in 7 (9.7%) and 4 (5.6%) patients in the HD and LD groups, respectively, without any significant difference between the two groups.In this study, the HD group had a significantly shorter fusion level and a more proximal LIV than the LD group; however, the two groups had similar curve correction and adverse radiological outcome rates.CONCLUSIONSIn this study, the HD group had a significantly shorter fusion level and a more proximal LIV than the LD group; however, the two groups had similar curve correction and adverse radiological outcome rates. |
| Author | Lee, Choon-Ki Kim, Hyoungmin Kim, Jae Hun Chang, Sam Yeol Mok, Sujung Chang, Bong-Soon |
| AuthorAffiliation | 2 Department of Orthopeadic Surgery, Uijeongbu Eulji University Hospital, Uijeongbu, Korea 1 Department of Orthopeadic Surgery, Seoul National University Hospital, Seoul, Korea |
| AuthorAffiliation_xml | – name: 2 Department of Orthopeadic Surgery, Uijeongbu Eulji University Hospital, Uijeongbu, Korea – name: 1 Department of Orthopeadic Surgery, Seoul National University Hospital, Seoul, Korea |
| Author_xml | – sequence: 1 givenname: Sam Yeol orcidid: 0000-0003-4152-687X surname: Chang fullname: Chang, Sam Yeol – sequence: 2 givenname: Jae Hun orcidid: 0000-0002-9589-6457 surname: Kim fullname: Kim, Jae Hun – sequence: 3 givenname: Sujung orcidid: 0000-0003-2789-4828 surname: Mok fullname: Mok, Sujung – sequence: 4 givenname: Bong-Soon orcidid: 0000-0002-8992-2559 surname: Chang fullname: Chang, Bong-Soon – sequence: 5 givenname: Choon-Ki orcidid: 0000-0001-7787-2972 surname: Lee fullname: Lee, Choon-Ki – sequence: 6 givenname: Hyoungmin orcidid: 0000-0002-4500-9653 surname: Kim fullname: Kim, Hyoungmin |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/36625017$$D View this record in MEDLINE/PubMed https://www.kci.go.kr/kciportal/ci/sereArticleSearch/ciSereArtiView.kci?sereArticleSearchBean.artiId=ART002955814$$DAccess content in National Research Foundation of Korea (NRF) |
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| CitedBy_id | crossref_primary_10_1016_j_wneu_2024_10_029 crossref_primary_10_1177_21925682231164344 crossref_primary_10_3390_jcm13082174 crossref_primary_10_3389_fsurg_2025_1607323 crossref_primary_10_1007_s43390_024_00860_9 crossref_primary_10_31616_asj_2024_0367 crossref_primary_10_1097_BPO_0000000000002444 |
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| Keywords | Instrumentation Scoliosis Rotation Pedicle screws Spinal fusion |
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| References_xml | – start-page: 1131 volume-title: Selective thoracic fusion in adolescent idiopathic scoliosis: factors influencing the selection of the optimal lowest instrumented vertebra year: 2011 ident: ref4 – ident: ref27 doi: 10.1186/s12891-017-1695-x – ident: ref18 doi: 10.1007/s00586-011-1808-4 – ident: ref7 doi: 10.1016/j.wneu.2019.12.087 – ident: ref19 doi: 10.1097/brs.0000000000000204 – ident: ref20 doi: 10.3171/2014.10.spine1496 – ident: ref33 doi: 10.1186/1748-7161-10-s1-o67 – ident: ref32 doi: 10.31616/asj.2020.0605 – ident: ref1 doi: 10.1097/01.brs.0000092216.16155.33 – ident: ref24 doi: 10.31616/asj.2020.0398 – ident: ref14 doi: 10.1097/01.brs.0000048653.75549.40 – ident: ref2 doi: 10.1097/brs.0b013e318279b666 – ident: ref25 doi: 10.1016/j.spinee.2016.11.012 – ident: ref11 doi: 10.1007/s00586-020-06353-3 – ident: ref15 doi: 10.3171/2011.4.spine10321 – ident: ref29 doi: 10.1186/s12891-019-2844-1 – ident: ref8 doi: 10.31616/asj.2018.0096 – start-page: E946 volume-title: Correction of Lenke 5 adolescent idiopathic scoliosis using pedicle screw instrumentation: does implant density influence the correction? year: 2013 ident: ref23 – ident: ref28 doi: 10.1177/2192568217735507 – ident: ref30 doi: 10.1007/s00586-014-3356-1 – ident: ref34 doi: 10.1097/brs.0b013e31828cb2a3 – ident: ref13 doi: 10.22603/ssrr.1.2016-0006 – start-page: E742 volume-title: Selecting the last “substantially” touching vertebra as lowest instrumented vertebra in Lenke type 1A curve: radiographic outcomes with a minimum of 2-year follow-up year: 2016 ident: ref31 – ident: ref17 doi: 10.2106/00004623-196951020-00002 – start-page: 1113 volume-title: Distal adding-on phenomenon in Lenke 1A scoliosis: risk factor identification and treatment strategy comparison year: 2011 ident: ref5 – ident: ref22 doi: 10.1016/j.spinee.2012.05.029 – start-page: 25 volume-title: Posterior correction and fusion surgery using pedicle-screw constructs for Lenke type 5C adolescent idiopathic scoliosis: a preliminary report year: 2015 ident: ref16 – ident: ref9 doi: 10.1016/j.wneu.2019.05.164 – ident: ref3 doi: 10.22603/ssrr.2018-0047 – start-page: 134 volume-title: Three-dimensional correction in patients with Lenke 1 adolescent idiopathic scoliosis: comparison of consecutive versus interval pedicle screw instrumentation year: 2016 ident: ref21 – ident: ref6 doi: 10.1097/brs.0000000000000126 – start-page: E50 volume-title: Long-term outcome of selective thoracic fusion using rod derotation and direct vertebral rotation in the treatment of thoracic adolescent idiopathic scoliosis: more than 10-year follow-up data year: 2020 ident: ref12 – ident: ref10 doi: 10.1097/01.brs.0000109991.88149.19 – ident: ref26 doi: 10.3171/2016.11.peds16334 |
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| Title | The Use of High-Density Pedicle Screw Construct with Direct Vertebral Derotation of the Lowest Instrumented Vertebra in Selective Thoracic Fusion for Adolescent Idiopathic Scoliosis: Comparison of Two Surgical Strategies |
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