Adult scoliosis correction: Clinical and radiographic comparison of techniques

2006

INTRODUCTION

This study compares outcomes in patients with adult scoliosis treated with the new direct vertebral translation technique compared to patients treated with rod derotation and in situ bending.

METHODS

Sixty consecutive adult scoliosis patients age 55 (20-80 yrs) underwent posterior correction by one surgeon, followed 4 yrs (2-11 yrs). Seventeen used rod derotation and in situ rod bending. Forty-three used direct vertebral translation by slowly pulling the spine to a contoured rod via pivoting reduction posts attached to screws, simultaneously correcting both coronal and sagittal deformity. Two patients from each group required osteotomies. Anterior surgery was required in 15/17 control and 39/43 direct translation patients. Oswestry, VAS, pain medication use, and work status were followed along with radiographs. Clinical and radiographic results were analyzed by curve type.

RESULTS

The direct translation group curves of 49° (range 17–83°) corrected 72% to 14° (4-40°) was better (P<0.01) than control group curves of 55° (25–84°) corrected 48% to 29° (10-59°). Idiopathic scoliosis of 58° (43–83°) in the translation group corrected 69% to 18° (7–40°) compared to 49% correction in the control group. Correction of translation group vs control group by curve type was: degenerative 67% vs 49%, thoracic 70% vs 51%, thoracolumbar 81% vs 44%, lumbar 74% vs 67% , double major 62% vs 34% . Control group complications included 3 nonunions (17%), 2 screw loosening (11%), 1 broken rod, 1 infection. The translation group had 4 nonunions (9%), 2 infections, no screw pullout. Eleven of 14 patients working pre-op returned to work. Oswestry and VAS score improvements were not statistically different between groups at 1 and 2 years.

CONCLUSION

This study shows statistically improved correction of adult scoliosis by direct vertebral translation using screws with pivoting reduction posts compared to other techniques. The most dramatic improvement was seen in patients with thoracolumbar and lumbar scoliosis. The technique appears to be very promising in patients with adult scoliosis.

SUMMARY

This study compares outcomes of 60 patients with adult scoliosis surgically treated using either rod derotation and in situ bending versus direct vertebral translation with screws containing pivoting reduction posts, followed 4 years. Direct vertebral translation was statistically superior (72% vs. 49%) in achieving deformity correction.