The effect of continued posterior spinal growth on sagittal contour in patients treated by anterior instrumentation for idiopathic scoliosis

Linda P. D'Andrea, Randal R. Betz, Lawrence G. Lenke, Jürgen Harms, David H. Clements, Thomas G. Lowe

Research output: Contribution to journalArticlepeer-review

25 Scopus citations

Abstract

Study Design. Retrospective analysis of radiographs on a prospective cohort of patients undergoing anterior instrumentation for thoracic idiopathic scoliosis. Objectives. To analyze the change in sagittal profile after growth. Summary of Background Data. The authors previously reported some advantages of anterior instrumentation for treatment of thoracic idiopathic scoliosis. However, postsurgery hyperkyphosis has resulted in some patients, especially those who were skeletally immature at the time of surgery. Methods. Inclusion criteria required that participants have thoracic idiopathic scoliosis treated with anterior instrumentation and a confirmed solid fusion, no rod breakage, and a minimum follow-up period of 2 years. The 47 patients meeting the criteria were divided into a study group of 10 patients who were Risser 0 at the time of surgery and a control group of 37 patients who were Risser 1 to 5. Progressive sagittal kyphosis was defined as an increase of 10°or more (T5-T12) after surgery. Results. Sagittal progression greater than 10°(average, 15°) occurred in 6 of 10 patients (60%) in the study group (Risser 0). Five patients progressed from 10°to 19°, and one patient from 20°to 30°. In contrast, sagittal progression occurred in only 10 of 37 patients (27%) in the control group (Risser 1 to 5). Conclusions. Some patients with thoracic adolescent idiopathic scoliosis treated with anterior instrumentation may be at risk for progressive sagittal kyphosis secondary to growth. Skeletal immaturity (Risser 0) appears to be a risk factor. In these immature patients, preserving the sagittal profile with intervertebral spacers, rigid rods, and bone graft (allowing for an average 15° increase of kyphosis with growth) may be appropriate.

Original languageEnglish
Pages (from-to)813-818
Number of pages6
JournalSpine
Volume25
Issue number7
DOIs
StatePublished - 1 Apr 2000
Externally publishedYes

Keywords

  • Anterior instrumentation
  • Idiopathic scoliosis
  • Sagittal contour
  • Spinal growth

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