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Influence of Derotation Connectors on 3D Surgical Correction of Adolescent Idiopathic Scoliosis

Allia, Jérémy MSc*; Clément, Jean-Luc MD*; Rampal, Virginie MD, PhD*; Leloutre, Béatrice MD; Rosello, Olivier MD*; Solla, Federico MD*

doi: 10.1097/BSD.0000000000000621
PRIMARY RESEARCH
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Study Design: Monocentric study comparing results of simultaneous translation on 2 rods (ST2R) with derotation connectors (prospective series) or without derotation connectors (retrospective series) in Adolescent Idiopathic Scoliosis (AIS) surgery.

Objective: The objective of this study was to assess if derotation connectors influence axial, coronal, and sagittal results in AIS surgery.

Summary of Background Data: Conventional reduction techniques remain limited in their ability to reduce axial torsion. Direct vertebral derotation technique accomplishes partial axial derotation but decreases thoracic kyphosis.

Methods: Monocentric study including AIS surgeries performed using ST2R technique with derotation connectors (group D+, n=44) or without derotation connectors (group D−, n=24). The axial intervertebral rotation was measured between apical and neutral vertebra on pre and postoperative computed tomography scan. T test was used to compare mean values. ANCOVA analyzed the influence of connectors and covariates on the primary outcome, which was the difference between preoperative and postoperative intervertebral rotation.

Results: The mean axial torsion gain in the D+ group was 23% (+3.84 degrees, 95% confidence interval, +1.95/+5.73). In the D− group, mean axial torsion increase of 4% (−0.42 degrees, 95% confidence interval, −1.19/+2.03). The result was significantly different between the 2 groups (P=0.005). The coronal correction of the main curve angle was 80% in the D+ group and 64% in the D− group (P=0.004). Kyphosis correction was similar between the 2 groups (P=0.3) with significant increase of thoracic kyphosis in the whole series (P=0.02) and no patients with postoperative hypokyphosis <10 degrees. Multivariate analysis confirmed the influence of derotation connectors on both axial and coronal correction (P<0.05).

Conclusions: The use of derotation connectors in the surgical treatment of AIS significantly improved axial and coronal correction compared to nonuse of connectors without compromising the sagittal plane.

*Pediatric Orthopaedic Surgery

Pediatric Radiology, Lenval University Children Hospital, Nice, France

F.S. and J.A.: received financial support for attending symposia and congresses from Medicrea International. J.-L.C.: is consultant for Medicrea International. The remaining authors declare that they have nothing to disclose.

Reprints: Federico Solla, MD, Scoliosis Surgery, Lenval University Children’s Hospital, 57, Avenue Californie, 06200 Nice, France (e-mail: solla.f@pediatrie-chulenval-nice.fr).

Received June 6, 2017

Accepted February 5, 2018

© 2018 by Lippincott Williams & Wilkins, Inc.