Can use of a stiffer rod obviate the need for posterior column osteotomy in Lenke I and II curves? A prospective, multi-center study.
Academic Article
Overview
abstract
PURPOSE: Surgical correction of adolescent idiopathic scoliosis (AIS) involves correction of coronal plane deformity to establish coronal and sagittal balance. Posterior column osteotomies (PCOs) are frequently employed but have been associated with complications. We hypothesize that utilization of a novel geometry rod construct will achieve comparable coronal and sagittal correction in AIS surgery regardless of whether PCOs are performed. METHODS: A single-arm, prospective, multi-center study was completed to evaluate the primary curve and thoracic kyphosis (TK) correction in Lenke 1 and 2 AIS subjects as a function of rod stiffness. Baseline, initial postoperative, and 2-year postoperative radiographs were used. Results from pooled literature were used for comparison. RESULTS: Fifty-five patients were included; 22 had PCOs (PCO group) and 33 did not (NPCO group). There were no differences between cohorts in terms of baseline demographics or radiographic features. Between the NPCO and PCO cohorts, no differences were seen in preoperative primary Cobb (58.0 vs 61.6, p = 0.1427), Flexibility (%) (41.4 vs 36.8, p = 0.2453), ultimate post-op primary curve size (17.0 vs 17.1, p = 0.9501) or degree of correction (pre-post, %) (70.6 vs 72.2, p = 0.4806). Those with PCOs had increased blood loss (NPCO: %EBV: 13.5, 543.0 cc, PCO: %EBV: 17.8, 717.6 cc, p = 0.0260), transfusion volume (NPCO: 171.7 mL, PCO: 429.9 mL, p = 0.0009), and surgical time (NPCO: 266.2 min, PCO: 297.1 min, p = 0.0434). Compared to previously published literature (LIT), our cohort had slightly higher average preoperative TK (Study = 21.5°, LIT: 19.8°, z = 0.1041) and postoperative TK (Study All = 23.4°, LIT = 21.7°, z = 0.0399 and Study PCO 24.7°, z = 0.0237). CONCLUSIONS: In our cohort, curves treated using a novel rod with increased rigidity, comparable corrections were achieved regardless of whether PCO was performed. We noted a higher intraoperative EBL and longer operative times when PCOs were utilized. LEVEL OF EVIDENCE: II.
