TY - JOUR
T1 - Direct vertebral body derotation, thoracoplasty, or both
AU - Samdani, Amer F.
AU - Hwang, Steven W.
AU - Miyanji, Firoz
AU - Lonner, Baron
AU - Marks, Michelle C.
AU - Sponseller, Paul D.
AU - Newton, Peter O.
AU - Cahill, Patrick J.
AU - Shufflebarger, Harry L.
AU - Betz, Randal R.
N1 - Publisher Copyright:
Copyright © 2012 Lippincott Williams & Wilkins.
PY - 2012/1/18
Y1 - 2012/1/18
N2 - Study Design. Prospective, longitudinal cohort (nonrandomized). Objective. To compare thoracoplasty (Th), direct vertebral body derotation (DVBD), and Th and DVBD with respect to correction of the rib prominence and Scoliosis Research Society (SRS) self-image scores in patients undergoing surgery for adolescent idiopathic scoliosis (AIS). Summary of Background Data. Rib prominence correction is one of the main goals of AIS surgery. Th and DVBD are powerful tools for correction of the rib prominence; however, a paucity of literature exists comparing Th, DVBD, and Th and DVBD. Methods. A prospective longitudinal database was queried to identify patients with AIS who underwent a posterior spinal fusion with pedicle screws and 2 years of follow-up. A total of 326 patients were identifi ed and divided into 3 groups: (1) Th alone (N = 47), (2) DVBD alone (N = 196), and (3) both Th and DVBD (N = 83). Patients were subdivided into categories on the basis of their preoperative inclinometer reading: (1) ≤ 9 ° (mild), (2) 10 to 15 ° (moderate), and (3) ≥ 16 ° (severe). Pre-and postoperative inclinometer readings and SRS self-image scores were compared using analysis of variance. Results. Overall, the groups were similar preoperatively except for the DVBD group having higher percentage of thoracic fl exibility. The preoperative rib prominence values were Th = 13.2, DVBD = 14.0, and Th and DVBD = 12.9 ( P = 0.27). Taken collectively, the postoperative 2-year inclinometer readings were similar for all 3 groups (Th = 5.2, DVBD = 7.0, Th and DVBD = 5.6; P = 0.66). However, the SRS-22 self-image scores were signifi cantly better for patients having both Th and DVBD (Th = 3.37, DVBD = 3.44, Th and DVBD = 3.76; P < 0.01). When patients were stratifi ed by severity of preoperative rib prominence, all patients with mild prominences achieved similar corrections, although SRS self-image scores were highest in the Th and DVBD group. In patients with larger rib prominences, the addition of Th was necessary for optimal rib prominence correction, but there was no difference in SRS-22 self-image scores. Conclusion. Our results suggest that Th alone, DVBD alone, or both Th and DVBD provide equivalent inclinometer results in patients with mild preoperative rib prominences ( ≤ 9 ° ), but higher SRS-22 self-image scores are achieved using both Th and DVBD. For larger rib prominences, better inclinometer readings are achieved with Th, although SRS-22 self-image scores are comparable.
AB - Study Design. Prospective, longitudinal cohort (nonrandomized). Objective. To compare thoracoplasty (Th), direct vertebral body derotation (DVBD), and Th and DVBD with respect to correction of the rib prominence and Scoliosis Research Society (SRS) self-image scores in patients undergoing surgery for adolescent idiopathic scoliosis (AIS). Summary of Background Data. Rib prominence correction is one of the main goals of AIS surgery. Th and DVBD are powerful tools for correction of the rib prominence; however, a paucity of literature exists comparing Th, DVBD, and Th and DVBD. Methods. A prospective longitudinal database was queried to identify patients with AIS who underwent a posterior spinal fusion with pedicle screws and 2 years of follow-up. A total of 326 patients were identifi ed and divided into 3 groups: (1) Th alone (N = 47), (2) DVBD alone (N = 196), and (3) both Th and DVBD (N = 83). Patients were subdivided into categories on the basis of their preoperative inclinometer reading: (1) ≤ 9 ° (mild), (2) 10 to 15 ° (moderate), and (3) ≥ 16 ° (severe). Pre-and postoperative inclinometer readings and SRS self-image scores were compared using analysis of variance. Results. Overall, the groups were similar preoperatively except for the DVBD group having higher percentage of thoracic fl exibility. The preoperative rib prominence values were Th = 13.2, DVBD = 14.0, and Th and DVBD = 12.9 ( P = 0.27). Taken collectively, the postoperative 2-year inclinometer readings were similar for all 3 groups (Th = 5.2, DVBD = 7.0, Th and DVBD = 5.6; P = 0.66). However, the SRS-22 self-image scores were signifi cantly better for patients having both Th and DVBD (Th = 3.37, DVBD = 3.44, Th and DVBD = 3.76; P < 0.01). When patients were stratifi ed by severity of preoperative rib prominence, all patients with mild prominences achieved similar corrections, although SRS self-image scores were highest in the Th and DVBD group. In patients with larger rib prominences, the addition of Th was necessary for optimal rib prominence correction, but there was no difference in SRS-22 self-image scores. Conclusion. Our results suggest that Th alone, DVBD alone, or both Th and DVBD provide equivalent inclinometer results in patients with mild preoperative rib prominences ( ≤ 9 ° ), but higher SRS-22 self-image scores are achieved using both Th and DVBD. For larger rib prominences, better inclinometer readings are achieved with Th, although SRS-22 self-image scores are comparable.
KW - Adolescent idiopathic scoliosis
KW - Direct vertebral body derotation
KW - Pedicle screws
KW - Thoracoplasty.
UR - http://www.scopus.com/inward/record.url?scp=84855906509&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84855906509&partnerID=8YFLogxK
U2 - 10.1097/BRS.0b013e31824a4911
DO - 10.1097/BRS.0b013e31824a4911
M3 - Article
C2 - 22261630
AN - SCOPUS:84855906509
SN - 0362-2436
VL - 37
SP - E849-E853
JO - Spine
JF - Spine
IS - 14
ER -