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Comparison of Surgical Treatment in Lenke 5C Adolescent Idiopathic Scoliosis: Anterior Dual Rod Versus Posterior Pedicle Fixation Surgery: A Comparison of Two Practices

Geck, Matthew J. MD; Rinella, Anthony MD; Hawthorne, Dana PA; Macagno, Angel MD; Koester, Linda BS; Sides, Brenda MA; Bridwell, Keith MD; Lenke, Lawrence MD; Shufflebarger, Harry MD

doi: 10.1097/BRS.0b013e3181a3c777
Deformity

Study Design. Multicenter analysis of 2 groups of patients surgically treated for Lenke 5C adolescent idiopathic scoliosis (AIS).

Objective. Compare patients with Lenke 5C scoliosis surgically treated with anterior spinal fusion with dual rod instrumentation and anterior column support with patients surgically treated with posterior release and pedicle screw instrumentation.

Summary of Background Data. Treatment of single, structural, lumbar, and thoracolumbar curves in patients with AIS has been the subject of some debate. Advocates of the anterior approach assert that their technique spares posterior musculature and may save distal fusion levels, and that with dual rods and anterior column support the issues with nonunion and kyphosis have been obviated. Advocates of the posterior approach assert that with the change to posterior pedicle screw based instrumentation that correction and levels are equivalent, and the posterior approach avoids the issues with nonunion and kyphosis. This report directly compares the results of posterior versus anterior instrumented fusions in the operative treatment of adolescent idiopathic Lenke 5C curves.

Methods. We analyzed 62 patients with Lenke 5C based on radiographic and clinical data at 2 institutions: 31 patients treated with posterior, pedicle-screw instrumented fusions at 1 institution (group PSF); and 31 patients with anterior, dual-rod instrumented fusions at another institution (group ASF). Multiple clinical and radiographic parameters were evaluated and compared.

Results. The mean age, preoperative major curve magnitude, and preoperative lowest instrumented vertebral (LIV) tilt were similar in both groups (age: PSF = 15.5 years, ASF = 15.6 years; curve size: PSF = 50.3° ± 7.0°, ASF = 49.0° ± 6.6°; LIV tilt: PSF = 27.5° ± 6.5°, ASF = 27.8° ± 6.2°). After surgery, the major curve corrected to an average of 6.3° ± 3.2° (87.6% ± 5.8%) in the PSF group, compared with 12.1° ± 7.4° (75.7% ± 14.8%) in the ASF group (P < 0.01). At final follow-up, the major curve measured 8.0° ± 3.0° (84.2% ± 5.8% correction) in the PSF group, compared with 15.9° ± 9.0° (66.6% ± 17.9%) in the ASF group (P = 0.01). This represented a loss of correction of 1.7° ± 1.9° (3.4% ± 3.7%) in the PSF group, and 3.8° ± 4.2° (9.4% ± 10.7%) in the ASF group (P = 0.028). The LIV tilt decreased to 4.1° ± 3.4° after surgery in the PSF group, and 4.5° ± 3.7° in the ASF group. At final follow-up, the LIV tilt was 5.1° ± 3.5° in the PSF group, and 4.5° ± 3.7° in the ASF group. EBL was identical in both groups, and length of hospital stay was significantly (P < 0.01) shorter in the PSF group (4.8 vs. 6.1 days). There were no complications in either group which extended hospital stay or required an unplanned second surgery.

Conclusion. At a minimum of 2-year follow-up, adolescents with Lenke 5C curves demonstrated statistically significantly better curve correction, less loss of correction over time, and shorter hospital stays when treated with a posterior release with pedicle screw instrumented fusion compared with an anterior instrumented fusion with dual rods for similar patient populations.

Sixty-two patients with Lenke 5C adolescent idiopathic scoliosis were analyzed at 2 institutions. Thirty-one were surgically treated with dual rod ASF and 31 patients were treated with PSF with pedicle screw instrumentation. There were no major complications. Patients treated with PSF demonstrated significantly better curve correction and shorter hospital stays.

From the Department of Orthopaedics, Spine Austin, Austin, TX.

Acknowledgment date: March 21, 2008. Revision date: October 28, 2008. Acceptance date: October 28, 2008.

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Matthew J. Geck, MD, Department of Orthopaedics, Spine Austin, 3001 Beecaves Road, Austin, TX 78746. E-mail: mattgeck@mac.com.

© 2009 Lippincott Williams & Wilkins, Inc.