Posterolateral Diskectomies for Treatment of Pediatric Spinal Deformities

Amit Jain, Brian T. Sullivan, Hamid Hassanzadeh, Nigel Hsu, Paul David Sponseller

Research output: Contribution to journalArticle

Abstract

STUDY DESIGN: Retrospective. OBJECTIVE: To investigate the indications, radiographic outcomes, and complications in children with spinal deformities treated with posterolateral diskectomy with posterior fusion (PLDF), and to compare them against those of patients treated with anteroposterior spinal fusion (APSF). SUMMARY OF BACKGROUND DATA: A novel technique for treating large, rigid spinal deformities in children has been proposed, consisting of PLDF at the apex of the deformity using an all-posterior approach. METHODS: We evaluated records of all patients 21 years or younger who underwent treatment for spinal deformity between 2010 and 2015 by one surgeon using PLDF (n = 56) or APSF (n = 21). RESULTS: The indications for PLDF were large, rigid curves (37 patients); focal curves with severe rotation (10 patients); or large curves with open triradiate cartilage (nine patients). PLDF patients had a mean (± standard deviation) of 3 ± 1 diskectomies and 14 ± 3 posterior spinal levels fused. Compared with the APSF group, the PLDF group had significantly greater major curve correction (86% vs. 57%, P = 0.006), less blood transfused (mean, 2.5 ± 2.6 vs. 4.0 ± 3.3 units, P = 0.038), and a lower rate of staged surgery (1.8% vs. 86%, P < 0.001). There were no significant differences between the PLDF and APSF groups in T1-S1 length gained (mean, 6.2 ± 3.4 vs. 6.6 ± 8.8 cm, respectively; P = 0.77) or in the rate of major complications (P = 0.557). CONCLUSION: PLDF is an effective alternative to APSF for treating children with severe spinal deformities. It is effective for treating large, rigid curves with severe rotation and may be useful for treating large curves in children with open triradiate cartilage.4.

Original languageEnglish (US)
Pages (from-to)1139-1145
Number of pages7
JournalSpine
Volume43
Issue number16
DOIs
StatePublished - Aug 1 2018

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Diskectomy
Pediatrics
Spinal Fusion
Therapeutics
Cartilage

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Posterolateral Diskectomies for Treatment of Pediatric Spinal Deformities. / Jain, Amit; Sullivan, Brian T.; Hassanzadeh, Hamid; Hsu, Nigel; Sponseller, Paul David.

In: Spine, Vol. 43, No. 16, 01.08.2018, p. 1139-1145.

Research output: Contribution to journalArticle

Jain, Amit ; Sullivan, Brian T. ; Hassanzadeh, Hamid ; Hsu, Nigel ; Sponseller, Paul David. / Posterolateral Diskectomies for Treatment of Pediatric Spinal Deformities. In: Spine. 2018 ; Vol. 43, No. 16. pp. 1139-1145.
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abstract = "STUDY DESIGN: Retrospective. OBJECTIVE: To investigate the indications, radiographic outcomes, and complications in children with spinal deformities treated with posterolateral diskectomy with posterior fusion (PLDF), and to compare them against those of patients treated with anteroposterior spinal fusion (APSF). SUMMARY OF BACKGROUND DATA: A novel technique for treating large, rigid spinal deformities in children has been proposed, consisting of PLDF at the apex of the deformity using an all-posterior approach. METHODS: We evaluated records of all patients 21 years or younger who underwent treatment for spinal deformity between 2010 and 2015 by one surgeon using PLDF (n = 56) or APSF (n = 21). RESULTS: The indications for PLDF were large, rigid curves (37 patients); focal curves with severe rotation (10 patients); or large curves with open triradiate cartilage (nine patients). PLDF patients had a mean (± standard deviation) of 3 ± 1 diskectomies and 14 ± 3 posterior spinal levels fused. Compared with the APSF group, the PLDF group had significantly greater major curve correction (86{\%} vs. 57{\%}, P = 0.006), less blood transfused (mean, 2.5 ± 2.6 vs. 4.0 ± 3.3 units, P = 0.038), and a lower rate of staged surgery (1.8{\%} vs. 86{\%}, P < 0.001). There were no significant differences between the PLDF and APSF groups in T1-S1 length gained (mean, 6.2 ± 3.4 vs. 6.6 ± 8.8 cm, respectively; P = 0.77) or in the rate of major complications (P = 0.557). CONCLUSION: PLDF is an effective alternative to APSF for treating children with severe spinal deformities. It is effective for treating large, rigid curves with severe rotation and may be useful for treating large curves in children with open triradiate cartilage.4.",
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