scholarly journals Deformity Correction Through the Use of Reduction Towers: 2-Dimensional Operative Video

2019 ◽  
Vol 19 (2) ◽  
pp. E157-E158
Author(s):  
Avery L Buchholz ◽  
Thomas J Buell ◽  
Mark E Shaffrey ◽  
Regis W Haid ◽  
Christopher I Shaffrey
Keyword(s):  
Cobb Angle ◽  
Sagittal Plane ◽  
Deformity Correction ◽  
X Rays ◽  
Transpedicular Instrumentation ◽  
Scoliosis Correction ◽  
Iliac Screw ◽  
Plane Deformity ◽  
Sagittal Malalignment ◽  
Sequential Reduction

Abstract Spinal deformity management can be difficult. The decision for surgery, approach, number of levels, and surgical technique all present challenges. Even when other issues are managed appropriately the process of how to correct the deformity needs special consideration. Numerous techniques have been studied including vertebra-to-rod, rod de-rotation, 3-rod-techniques, and cantilever maneuvers. While cantilever is the preferred technique when treating sagittal plane deformity, scoliosis often requires a combination of techniques due to the complexity of deformity in coronal and transverse planes. This video illustrates an adult scoliosis correction using sequential reduction towers and de-rotation techniques. Using this method the step of hook holders is eliminated and tension is distributed evenly across the rod using sequential reduction of the reduction towers across the length of the rod. This has led to a very efficient correction of our deformity as well as a powerful de-rotation tool. We routinely use this technique for flexible and rigid deformities, which is assessed pre-op with a computed tomography. The patient is a 67-yr-old female with prior lumbar decompressions and worsening back pain with radiculopathy. No significant sagittal malalignment is present but pelvic tilt is elevated and a coronal deformity exists. pelvic incidence measures 59°, LL50°, PT28° and lumbar scoliosis shows a coronal Cobb angle of 50.8°. Briefly, surgery involved transpedicular instrumentation from T10-S1 with bilateral iliac screw fixation. To achieve mobility posterior column osteotomies were performed at T12-L1, L1-2, L2-3, L3-4, L4-5, and L5-S1 levels. TLIF was performed at L4-5, L5-S1 for fusion. Postoperative scoliosis X-rays demonstrated improved sagittal and coronal alignment with PI59°, LL59°, PT22°, and coronal Cobb angle of 12°.

Lateral Thoracolumbar Listhesis as an Independent Predictor of Disability in Adult Scoliosis Patients: Multivariable Assessment Before and After Surgical Realignment

Neurosurgery ◽  
2021 ◽  
Author(s):  
Alan H Daniels ◽  
Wesley M Durand ◽  
Renaud Lafage ◽  
Andrew S Zhang ◽  
David K Hamilton ◽  
...  
Keyword(s):  
Cobb Angle ◽  
Multivariable Analysis ◽  
Deformity Correction ◽  
Adult Scoliosis ◽  
Leg Pain ◽  
Minimally Clinically Important Difference ◽  
Before And After ◽  
Plane Deformity ◽  
Numeric Scale

Abstract BACKGROUND Lateral (ie, coronal) vertebral listhesis may contribute to disability in adult scoliosis patients. OBJECTIVE To assess for a correlation between lateral listhesis and disability among patients with adult scoliosis. METHODS This was a retrospective multi-center analysis of prospectively collected data. Patients eligible for a minimum of 2-yr follow-up and with coronal plane deformity (defined as maximum Cobb angle ≥20º) were included (n = 724). Outcome measures were Oswestry Disability Index (ODI) and leg pain numeric scale rating. Lateral thoracolumbar listhesis was measured as the maximum vertebral listhesis as a percent of the superior endplate across T1-L5 levels. Linear and logistic regression was utilized, as appropriate. Multivariable analyses adjusted for demographics, comorbidities, surgical invasiveness, maximum Cobb angle, and T1-PA. Minimally clinically important difference (MCID) in ODI was defined as 12.8. RESULTS In total, 724 adult patients were assessed. The mean baseline maximum lateral thoracolumbar listhesis was 18.3% (standard deviation 9.7%). The optimal statistical grouping for lateral listhesis was empirically determined to be none/mild (<6.7%), moderate (6.7-15.4%), and severe (≥15.4%). In multivariable analysis, listhesis of moderate and severe vs none/mild was associated with worse baseline ODI (none/mild = 33.7; moderate = 41.6; severe = 43.9; P < .001 for both comparisons) and leg pain NSR (none/mild = 2.9, moderate = 4.0, severe = 5.1, P < .05). Resolution of severe lateral listhesis to none/mild was independently associated with increased likelihood of reaching MCID in ODI at 2 yr postoperatively (odds ratio 2.1 95% confidence interval 1.2–3.7, P = .0097). CONCLUSION Lateral thoracolumbar listhesis is associated with worse baseline disability among adult scoliosis patients. Resolution of severe lateral listhesis following deformity correction was independently associated with increased likelihood of reaching MCID in ODI at 2-yr follow-up.

A Critical Analysis of Sagittal Plane Deformity Correction with Minimally Invasive Adult Spinal Deformity Surgery: A Two-Year Follow-Up Study

2015 ◽  
Vol 15 (10) ◽  
pp. S126-S127
Author(s):  
International Spine Study Group ◽  
Gregory M. Mundis ◽  
Jay D. Turner ◽  
Vedat Deviren ◽  
Juan S. Uribe ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Spinal Deformity ◽  
Critical Analysis ◽  
Sagittal Plane ◽  
Adult Spinal Deformity ◽  
Deformity Correction ◽  
Follow Up Study ◽  
Spinal Deformity Surgery ◽  
Plane Deformity

scholarly journals Limitations and ceiling effects with circumferential minimally invasive correction techniques for adult scoliosis: analysis of radiological outcomes over a 7-year experience

2014 ◽  
Vol 36 (5) ◽  
pp. E14 ◽  
Author(s):  
Neel Anand ◽  
Eli M. Baron ◽  
Babak Khandehroo
Keyword(s):  
Minimally Invasive ◽  
Cobb Angle ◽  
Lumbar Lordosis ◽  
Sagittal Plane ◽  
Adult Scoliosis ◽  
Angle Correction ◽  
Scoliosis Correction ◽  
Spinopelvic Parameter ◽  
Ceiling Effects ◽  
The Mean

Object Minimally invasive correction of adult scoliosis is a surgical method increasing in popularity. Limited data exist, however, as to how effective these methodologies are in achieving coronal plane and sagittal plane correction in addition to improving spinopelvic parameters. This study serves to quantify how much correction is possible with present circumferential minimally invasive surgical (cMIS) methods. Methods Ninety patients were selected from a database of 187 patients who underwent cMIS scoliosis correction. All patients had a Cobb angle greater than 15°, 3 or more levels fused, and availability of preoperative and postoperative 36-inch standing radiographs. The mean duration of follow-up was 37 months. Preoperative and postoperative Cobb angle, sagittal vertical axis (SVA), coronal balance, lumbar lordosis (LL), and pelvic incidence (PI) were measured. Scatter plots were performed comparing the pre- and postoperative radiological parameters to calculate ceiling effects for SVA correction, Cobb angle correction, and PI-LL mismatch correction. Results The mean preoperative SVA value was 60 mm (range 11.5–151 mm); the mean postoperative value was 31 mm (range 0–84 mm). The maximum SVA correction achieved with cMIS techniques in any of the cases was 89 mm. In terms of coronal Cobb angle, a mean correction of 61% was noted, with a mean preoperative value of 35.8° (range 15°–74.7°) and a mean postoperative value of 13.9° (range 0°–32.5°). A ceiling effect for Cobb angle correction was noted at 42°. The ability to correct the PI-LL mismatch to 10° was limited to cases in which the preoperative PI-LL mismatch was 38° or less. Conclusions Circumferential MIS techniques as currently used for the treatment of adult scoliosis have limitations in terms of their ability to achieve SVA correction and lumbar lordosis. When the preoperative SVA is greater than 100 mm and a substantial amount of lumbar lordosis is needed, as determined by spinopelvic parameter calculations, surgeons should consider osteotomies or other techniques that may achieve more lordosis.

scholarly journals The Results of Hemivertebra Resection by the Posterior Approach in Children with a Mean Follow-Up of Five Years

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Ramazan Erden Erturer ◽  
Bekir Eray Kilinc ◽  
Bahadir Gokcen ◽  
Sinan Erdogan ◽  
Kursat Kara ◽  
...  
Keyword(s):  
Postoperative Period ◽  
Sagittal Plane ◽  
Operating Time ◽  
Deformity Correction ◽  
Pedicle Screws ◽  
Early Postoperative Period ◽  
X Rays ◽  
Hemivertebra Resection ◽  
The Mean

Aim. To evaluate the radiologic and clinical results of patients who underwent deformity correction and stabilization for congenital spinal deformities using pedicle screws after hemivertebra resection. Material and Method. Nine patients, mean age 9.2, who underwent posterior hemivertebrectomy and transpedicular fixation for congenital spinal deformity and had longer than five years of follow-up were evaluated retrospectively. The hemivertebrae were located in the thoracic region in 4 patients and thoracolumbar transition region in 5 patients. The patients were evaluated radiologically and clinically in the postoperative period. Results. Mean length of follow-up was 64.2 months. The mean operating time was 292 minutes. The mean blood loss was 236 mL. The average hospitalization time was 7 days. The amount of correction on the coronal planes was measured as 31%. The mean segmental kyphosis angle was 45.7 degrees preoperatively and it was measured 2.7 degrees in the follow-up period. There were no statistically significant differences between the early postoperative period and final follow-up X-rays with respect to coronal and sagittal plane deformities. Conclusion. The ability to obtain a sufficient and balanced correction in the cases accompanied by long compensator curvatures that have a structural character in hemivertebra may require longer fusion levels.

scholarly journals The Height Gain in Scoliotic Deformity Correction: Assessed by New Predictive Formula

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Ahmet Yılmaz Şarlak ◽  
Halil Atmaca ◽  
Resul Musaoğlu ◽  
Elşen Veli Veliev
Keyword(s):  
Cobb Angle ◽  
Deformity Correction ◽  
Simple Expression ◽  
Height Loss ◽  
Mathematical Formula ◽  
Scoliotic Deformity ◽  
Scoliosis Correction ◽  
Height Gain ◽  
Predicted Height ◽  
New Formula

Height gain after scoliosis correction is of a special interest for the patient and family. Ylikoski was the first to suggest a formula predicting height loss in untreated scoliotic patients. Stokes has recently suggested a new formula by using Cobb angle to determine height loss in idiopathic curves. We hypothesized that new additional variables to Cobb angle such as apical vertebral translation (AVT), number of instrumented segments (N), and disc heights may increase the accuracy of predicted height gain. According to our findings simple expression for height gain by simplified version of the formula is:SPΔH=0.0059X1θ1 + 2.3(1−(θ2/θ1))N, whereθ1is preoperative Cobb angle,X1is preoperative AVT,θ2is postoperative Cobb angle, andNis the number of instrumented vertebra. The purpose of this study is to analyze a new mathematical formula to predict height gain after scoliotic deformity correction.

Longitudinal Radiographic Assessment of Maintenance of Sagittal Plane Deformity Correction Following Three-Column Spinal Osteotomy

2012 ◽  
Vol 12 (9) ◽  
pp. S154-S155
Author(s):  
Mostafa H. El Dafrawy ◽  
Virginie Lafage ◽  
Richard Hostin ◽  
Christopher P. Ames ◽  
Justin S. Smith ◽  
...  
Keyword(s):  
Sagittal Plane ◽  
Deformity Correction ◽  
Radiographic Assessment ◽  
Spinal Osteotomy ◽  
Plane Deformity
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