General Session: Pediatric Spine - Hall F
Presented by: L. Oggiano
L. Oggiano(1), S. Sessa(1), C. Curri(1), G. La Rosa(1)
(1) Bambino Gesù Children's Hospital, Department of Surgery, Rome, Italy
Introduction: We report perioperative and 3-year results in a consecutive series of adolescents affected by double-curve idiopathic scoliosis alternatively treated by instrumentation only at the convex side of each curve versus all-level one side pedicle screws instrumentation.
Material and Methods: From January 2014 to January 2016 we surgical treated 24 consecutive patients (19 F, 5 M, mean age 13 years) affected by double curve adolescent idiopathic scoliosis (Lenke type 3, 18 patients, and Lenke type 6, 6 patients). The population was divided in two groups: in group 1 (16 patients) we performed an instrumentation using polyaxial pedicle screws only at the convex side of each curve; in group 2 (8 patients) we performed an all level one side pedicle screws instrumentation, covering both the convexity and the concavity at the side of instrumentation. In all cases motor-evoked potentials monitoring was used. Mean follow-up time was 34 months.
Results: The average percentage of coronal correction was similar in two groups (74±5% in group 1 and 79±4% in group 2), with no neurological complications. In group 1 we performed a simultaneous bilateral derotation and manipulation on both convex side of the curves, instead in group 2 we performed a unilateral derotation and correction maneuvers on the side of the instrumentation. Concerning the post-operative thoracic kyphosis, we observed a slight decrease of mean values compared to pre-operative measurements (mean reduction of thoracic kyphosis 5°±2°). The operative time was a little bit different between the two groups (210±30 minutes in group 1 and 230±30 in group 2) with a comparable mean blood loss (600±100 ml). At 34-month follow-up no substantial changes in coronal nor in sagittal plane were observed.
Conclusion: This case-series study shows the effectiveness and the safety of convex manipulation in Lenke type 3 and type 6 scoliosis. The coronal correction obtained with this technique is comparable to that obtained with the traditional concave derotation. Other advantages are the short operative time, the low intra-operative blood loss and, mostly, a lower risk of neurological complications. Unlike the single curves, the management of double curves by only convex instrumentation requires a simultaneous derotation of both curve, in order to achieve the maximum correction of the deformity.