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Long‐Term Follow‐Up of Thoracic Idiopathic Scoliosis with Pedicle Screw Instrumentation ‐ More Than 10 Years Follow‐Up: *Paper #7

Suk, Se‐ll MD; Kim, Jin‐Hyok; Lim, Dong‐Ju doctor; Kim, Sung‐Soo; Kim, Tae‐Hyung; Han, Jung‐ll; Korea, Seung‐Hyun Choi

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Summary: Selective thoracic fusion in thoracic idiopathic scoliosis was well maintained in 10 years follow up.

Introduction: Selective thoracic fusion with pedicle screw instrumentation has been proven to be an effective method. The purpose of this paper is to evaluate the outcome of selective thoracic fusion with pedicle screw fixation in thoracic idiopathic scoliosis with a minimum 10 year follow‐up.

Methods: Ninety idiopathic scoliosis patients with 113 thoracic curves corrected by segmental pedicle screw fixation were analyzed. The minimum follow‐up was 10 yrs (10˜15.1 yrs). The deformity correction and spinal balance were evaluated by preop and postop standing PA and lateral radiographs. Measurements were made preoperatively, in 1 month, 1, 2, 5 yr and most recent follow‐up.

Results: A total of 1,332 thoracic pedicle screws were inserted in the thoracic region (T1 ˜T12). The average age at the time of operation was 14.6 yrs (8.9˜22.4 yrs).The preop thoracic curve of 53.0 was corrected to 14.8 (71.8% correction) at 1 month after surgery. At latest follow up the curve correction was 16.4 (69.1%, 2.6% loss of correction). The non‐instrumented lumbar curve of 31.7 was corrected to 9.6 (71.1% correction) at 1 month after surgery and measured 10.2 (69.6% correction, 0.6% loss of correction) at most recent follow‐up. The preop thoracic kyphosis of 17.6 was improved to 23.1 one month after surgery and the 22.6 at latest follow up. The lumbar lordosis of 43.7 was corrected to 44.4 one month after surgery and was 45.7 at most recent follow‐up. Coronal decompensation occurred in 6 patients in most recent follow‐up. Postop distal adding on occurred in 16 patients who were fused short of the neutral vertebra. Adding on was seen in 6 patients in postop 1 year, 4 in 2 years and 6 in 5 years. No thoracic hypokyposis or junctional kyphosis was found.

Conclusion: Selective thoracic fusion with pedicle screw fixation in thoracic idiopathic scoliosis resulted in correction that was well maintained in long term follow up over 10 years. There was no change of correction after 5 years. Distal fusion to the neutral vertebra was imperative to avoid adding on deformity that occurred up to 5 years postoperatively.

Significance: Selective thoracic fusion in thoracic idiopathic scoliosis was well maintained in 10 years follow up.

© 2010 Lippincott Williams & Wilkins, Inc.

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