scholarly journals Clinical evaluation of the ability of a proprietary scoliosis traction chair to de-rotate the spine: 6-month results of Cobb angle and rotational measurements

2014 ◽  
Vol 4 (2) ◽  
Author(s):  
Clayton J. Stitzel ◽  
Brian Dovorany ◽  
Mark W. Morningstar ◽  
Aatif Siddiqui
Keyword(s):  
Cobb Angle ◽  
Clinical Evaluation ◽  
Vertebral Rotation ◽  
Clinical Use ◽  
Stress Radiography ◽  
Apical Vertebral Rotation ◽  
Apical Rotation ◽  
Scoliosis Correction ◽  
Curve Patterns

The aim of this study was to investigate the immediate and 6-month effects of a scoliosis traction chair on scoliosis rotation and Cobb angle. The scoliosis traction chair has been used clinically for 10 years and has been part of previous studies, but has not been the focus of any previous study. Our goal was to test the scoliosis traction chair’s ability to de-rotate the spine to create scoliosis correction. Fifteen patient files were retrospectively selected for study. Patients were radiographically studied in a proprietary traction chair to evaluate impact on Cobb angle and apical vertebral rotation. Six-month follow-up results were recorded. Six-month results showed an average overall Cobb angle increase of about 7°. Patients with in-chair apical de-rotation showed 9° of Cobb angle improvement, while those with increased in-chair apical rotation showed an average 16° progression. Scoliotic curves whose apical rotation worsened on stress radiography showed deterioration of the curve at 6 months. Those with improved apical rotation showed Cobb angle corrections at 6 months. Since progression of scoliotic curvatures was observed in our cohort of patients after 6 months of home and clinical use, it is imperative that further studies attempt to qualify which patients and scoliosis curve patterns are best suited for the scoliosis traction chair.

scholarly journals Hybrid versus Total Sublaminar Wires in Patients With Spinal Muscular Atrophy Undergoing Scoliosis Surgery

2021 ◽  
Author(s):  
Shih-Hsiang Chou ◽  
Wen-Wei Li ◽  
Cheng-Chang Lu ◽  
Kun-Ling Lin ◽  
Sung-Yen Lin ◽  
...  
Keyword(s):  
Spinal Muscular Atrophy ◽  
Pedicle Screw ◽  
Muscular Atrophy ◽  
Deformity Correction ◽  
Vertebral Rotation ◽  
Major Curve ◽  
Apical Vertebral Rotation ◽  
Hybrid Instrumentation ◽  
Hybrid Construct

Abstract BackgroundEarly versions of spinal muscular atrophy (SMA) scoliosis correction surgeries often involved sublaminar devices. Recently the utilization of pedicle screw is gaining much popularity. Pedicle screw generally believed to provide additional deformity correction, but pedicle size and rotational deformity limit the application of pedicle screw in the thoracic spine, resulting in a hybrid construct of the pedicle screw and sublaminar wire. Studies of the efficacy of hybrid instrumentation in SMA scoliosis is often limited by the scarcity of the disease itself. In this study, we aimed to compare the surgical outcome of using hybrid constructs of the pedicle screw and sublaminar wire and that of sublaminar wire alone in patients with SMA scoliosis.MethodsWe retrospectively reviewed the clinical records and radiographic assessments of patients with SMA scoliosis who underwent corrective surgery between 1993 and 2015. The radiographic assessments included the deformity correction and the progressive change of major curve angle, pelvic tilt (PT) and coronal balance (CB). The correction of deformities was observed postoperatively and at the patient’s 2-year follow-up to test the efficacy of each type of constructs.ResultsThirty-three patients were included in this study. There were 14 and 19 patients in the wiring and the hybrid construct groups, respectively. The hybrid construct demonstrated a higher major curve angle correction (50.5° ± 11.2° vs. 36.4° ± 8.4°, p < 0.001), a higher apical vertebral rotation correction (10.6° ± 3.9° vs. 4.8° ± 2.6°, p < 0.001), and reduced the progression of major curve angle after the 2-year follow-up (5.1° ± 2.9° vs. 8.7° ± 4.8°, p < 0.001). A moderate correlation was observed between the magnitude of correction of apical vertebral rotation angle and major curve (r = 0.528, p = 0.002).ConclusionThis study demonstrated that hybrid instrumentation can provide a greater magnitude of correction in major curve and apical rotation, as well as less major curve progression in comparison with sublaminar wire in patients with SMA scoliosis.Level of evidence III

Concave or convex rod translation first in adolescent idiopathic scoliosis instrumentation with differential rod contouring?

2021 ◽  
Author(s):  
X Wang ◽  
CE Aubin ◽  
RM Schwend
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Cobb Angle ◽  
Thoracic Kyphosis ◽  
Deformity Correction ◽  
Vertebral Rotation ◽  
Convex Side ◽  
Bone Screw ◽  
Apical Vertebral Rotation ◽  
Clinically Significant

The objective was to assess deformity correction and bone-screw force associated respectively with concave manipulation first, convex manipulation first, and different differential rod contouring configurations. Instrumentation scenarios were computationally simulated for 10 AIS cases with mean thoracic Cobb angle (MT) of 54±8°, apical vertebral rotation (AVR) of 19±2° and thoracic kyphosis of 21±9°. Instrumentations with major correction maneuvers using the concave side rod were first simulated; instrumentations with major correction maneuvers using the convex side rod were then simulated. Simulated correction maneuvers were concave/convex rod translation followed by apical vertebral derotation and then convex/concave rod translation. There were no significant differences in deformity corrections and bone-screw forces between concave rod translation first and convex rod translation first with differential rod contouring. Increasing differential rod contouring angle and concave rod diameter improved AVR correction and increased the TK and bone-screw forces; the effect on the MT Cobb angle was not clinically significant.

A Novel Method for Estimating Three-Dimensional Apical Vertebral Rotation Using Two-Dimensional Coronal Cobb Angle and Thoracic Kyphosis

2017 ◽  
Vol 5 (4) ◽  
pp. 244-249 ◽  
Author(s):  
T. Barrett Sullivan ◽  
Tracey Bastrom ◽  
Fredrick Reighard ◽  
Megan Jeffords ◽  
Peter O. Newton
Keyword(s):  
Cobb Angle ◽  
Thoracic Kyphosis ◽  
Three Dimensional ◽  
Vertebral Rotation ◽  
Two Dimensional ◽  
Apical Vertebral Rotation ◽  
Novel Method

Follow-up of an Elongation Bending Derotation Brace in the treatment of infantile scoliosis

2021 ◽  
Author(s):  
J Thometz ◽  
XC Liu
Keyword(s):  
Cobb Angle ◽  
Vertebral Rotation ◽  
Spinal Deformities ◽  
Spica Casting ◽  
Cad Cam ◽  
Axial Vertebral Rotation ◽  
Pre Treatment ◽  
Infantile Scoliosis ◽  
Radiographic Changes

Since 2013, an elongation bending derotation brace (EBDB) has been developed and applied to EOS in our institution. The goals of the study were: 1) to compare radiographic changes before the use of EBDB (Pre-B), in brace (IB), and after the use of EBDB (Post-B) in a minimal two year follow-up; 2) to determine the compliance with the EBDB. Thirteen children diagnosed with an infantile scoliosis (IS) were retrospectively recruited. Under general anesthesia in the OR, child was placed on a Spica casting table, and the spine was manipulated by stockinet straps. Then 3D child’s torso was scanned, the EBDB was designed and manufactured for exact fitting to the torso in the corrected position using CAD/CAM technology.1 Mean age at start of EBDB was 2 years and 6 months. Average follow-up was 36 months. Compliance showed a mean 19 hours per day (14 to 23 hours). Pre-treatment Cobb angle was 40°, in brace 22°, and out of brace 28° (p<0.05). Axial vertebral rotation (AVR) by Nash-Moe method improved from 30% before treatment to 21% in brace and 19% at the end of visit (p<0.05). Kyphosis was significantly increased from 16° (Pre-B) to 32° (Post-B) (P<0.05). However, there was reduction of Rib-vertebral angle difference (RVAD) from 23° (Pre-B) to 11° (Post-B) (P>0.05). A cascade of EBDB effectively corrects and stabilizes the 3D spinal deformities in infantile. Thus the EBDB is considered as a successful modality in the treatment of IS children.

scholarly journals Hybrid versus total sublaminar wires in patients with spinal muscular atrophy undergoing scoliosis surgery

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Shih-Hsiang Chou ◽  
Wen-Wei Li ◽  
Cheng-Chang Lu ◽  
Kun-Ling Lin ◽  
Sung-Yen Lin ◽  
...  
Keyword(s):  
Spinal Muscular Atrophy ◽  
Muscular Atrophy ◽  
Deformity Correction ◽  
Pedicle Screws ◽  
Vertebral Rotation ◽  
Major Curve ◽  
Apical Vertebral Rotation ◽  
Hybrid Instrumentation ◽  
Hybrid Construct

Abstract Background Early versions of spinal muscular atrophy (SMA) scoliosis correction surgery often involved sublaminar devices. Recently, the utilization of pedicle screws has gained much popularity. Pedicle screws are generally believed to provide additional deformity correction, but pedicle size and rotational deformity limit their application in the thoracic spine, resulting in a hybrid construct involving pedicle screws and sublaminar wire. Studies of the efficacy of hybrid instrumentation in SMA scoliosis are often limited by the scarcity of the disease itself. In this study, we aimed to compare the surgical outcomes between hybrid constructs involving pedicle screws and sublaminar wire and sublaminar wire alone in patients with SMA scoliosis. Methods We retrospectively reviewed the clinical records and radiographic assessments of patients with SMA scoliosis who underwent corrective surgery between 1993 and 2017. The radiographic assessments included deformity correction and progressive changes in the major curve angle, pelvic tilt (PT) and coronal balance (CB). The correction of deformities was observed postoperatively and at the patient’s 2-year follow-up to test the efficacy of each type of construct. Results Thirty-three patients were included in this study. There were 14 and 19 patients in the wiring and hybrid construct groups, respectively. The hybrid construct group demonstrated a higher major curve angle correction (50.5° ± 11.2° vs. 36.4° ± 8.4°, p < 0.001), a higher apical vertebral rotation correction (10.6° ± 3.9° vs. 4.8° ± 2.6°, p < 0.001), and a reduced progression of the major curve angle at the 2-year follow-up (5.1° ± 2.9° vs. 8.7° ± 4.8°, p < 0.001). A moderate correlation was observed between the magnitude of correction of the apical vertebral rotation angle and the major curve (r = 0.528, p = 0.002). Conclusion This study demonstrated that hybrid instrumentation can provide a greater magnitude of correction in major curve and apical rotation as well as less major curve progression than sublaminar wire instrumentation alone in patients with SMA scoliosis. Level of evidence III

scholarly journals Simultaneous translation on two rods improves the correction and apex translocation in adolescent patients with hypokyphotic scoliosis

2021 ◽  
Vol 34 (4) ◽  
pp. 597-607
Author(s):  
Daisuke Sakai ◽  
Jordy Schol ◽  
Akihiko Hiyama ◽  
Hiroyuki Katoh ◽  
Masahiro Tanaka ◽  
...  
Keyword(s):  
Cobb Angle ◽  
Research Society ◽  
Rib Hump ◽  
Scoliosis Research Society ◽  
Correction Rate ◽  
Apical Vertebral Rotation ◽  
Matched Case ◽  
Simultaneous Translation ◽  
Time Point

OBJECTIVE The objectives of this study were to apply the simultaneous translation on two rods (ST2R) maneuver involving rods contoured with a convexity at the desired thoracic kyphosis (TK) apex level and to assess the effects on the ability to support triplanar deformity corrections, including TK apex improvement, in patients with hypokyphotic adolescent idiopathic scoliosis (AIS). METHODS Using retrospective analysis, the authors examined the digital records that included 2- to 4-week, 1-year, and 2-year postoperative radiographic follow-up data of female hypokyphotic (TK < 20°) AIS patients (Lenke type 1–3) treated with ST2R. The authors assessed the corrections of triplanar deformities by examining the main Cobb angle, TK, rib hump, apical vertebral rotation, Scoliosis Research Society 22-item questionnaire scores, and TK apex translocation. In order to better grasp the potential of ST2R, the outcomes were compared with those of a historical matched case-control cohort treated with a standard rod rotation (RR) maneuver. RESULTS Data were analyzed for 25 AIS patients treated with ST2R and 27 patients treated with RR. The ST2R group had significant improvements in the main Cobb angle and TK, reduction in the rib hump size at each time point, and a final correction rate of 72%. ST2R treatment significantly increased the kyphosis apex by an average of 2.2 levels. The correction rate was higher at each time point in the ST2R group than in the RR group. ST2R engendered favorable TK corrections, although the differences were nonsignificant, at 2 years compared with the RR group (p = 0.056). The TK apex location was significantly improved in the ST2R cohort (p < 0.001). At the 1-month follow-up, hypokyphosis was resolved in 92% of the ST2R cohort compared with 30% of the RR cohort. CONCLUSIONS Resolving hypokyphotic AIS remains challenging. The ST2R technique supported significant triplanar corrections, including TK apex translocation and restoration of hypokyphosis in most patients. Comparisons with the RR cohort require caution because of differences in the implant profile. However, ST2R significantly improved the coronal and sagittal corrections. It also allowed for distribution of correctional forces over two rod implants instead of one, which should decrease the risk of screw pullout and rod flattening. It is hoped that the description here of commercially available reducers used with the authors’ surgical technique will encourage other clinicians to consider using the ST2R technique.

scholarly journals Gerinckorrekciós műtétek háromdimenziós hatékonysági vizsgálata serdülőkori idiopathiás gerincferdülésben

2021 ◽  
Vol 162 (39) ◽  
pp. 1573-1578
Author(s):  
Kristóf József ◽  
István Márkus ◽  
Csaba Bogyó ◽  
Miklós Tunyogi Csapó ◽  
Ádám Tibor Schlégl
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Age Groups ◽  
The Elderly ◽  
Vertebral Rotation ◽  
Three Dimensions ◽  
Coronal Plane ◽  
Apical Vertebral Rotation ◽  
Scoliosis Correction ◽  
Before And After

Összefoglaló. Bevezetés: Nincs egységesen elfogadott álláspont, hogy a serdülőkori idiopathiás gerincferdülés sebészi korrekcióját melyik életkorban optimális elvégezni. Világszerte 11 éves kortól akár (kezeletlen esetben) 50–60 éves korig végeznek fúziós műtétet a betegségben, 63–83%-os átlagos koronális síkú korrekciós hatékonysággal. Célkitűzés: Célul tűztük ki, hogy felmérjük a gerinckorrekciós műtétek hatékonyságát három dimenzióban, illetve a páciens életkorának függvényében. Módszerek: A vizsgálatba 23, serdülőkori idiopathiás gerincferdüléssel diagnosztizált beteget (12 fő 17 évnél fiatalabb, 11 fő 17 évnél idősebb) vontunk be. Minden betegnél csavaros derotációt és spondylodesist végeztünk, és a beavatkozás előtt és után EOS 2D/3D felvételeket, majd sterEOS 3D rekonstrukciókat készítettünk. A következő paramétereket számítottuk: Cobb-fok, háti kyphosis, ágyéki lordosis, apicalis csigolyarotáció, maximális csigolyarotáció. A különböző életkorú csoportok közötti különbséget kétmintás t-próbával, illetve Wilcoxon-féle próbával vizsgáltuk. Eredmények: A gerinckorrekciós műtétek során a koronális síkú eltérést 78,2%-ban (átlagosan 55,1 Cobb-fokról 12,0 Cobb-fokra), az apicalis csigolyarotációt 56,7%-ban (átlagosan 21,0 fokról 9,1 fokra) tudtuk korrigálni. A 17 éves életkor után operált páciensek esetén átlagosan 79,2%-os Cobb-fok-csökkenést értünk el, míg a fiatalabb betegcsoportban 77,0%-ban korrigáltuk a koronális főgörbületet (p = 0,614). Az idősebb betegcsoportban szignifikánsan kevésbé sikerült az apicalis csigolyarotáció korrekciója (átlagosan 38,1%; 21,8 fokról 12,4 fokra), mint a fiatalabb pácienseknél (átlagosan 68,5%; 20,2 fokról 6,2 fokra; p = 0,016). Következtetés: Összességében a nemzetközi publikációknak megfelelő korrekciót értünk el. A koronális síkban közel azonos korrekciós hatékonyság figyelhető meg a különböző életkorú betegcsoportok között, a csigolyarotáció azonban 17 éves életkor előtt hatékonyabban korrigálható. Orv Hetil. 2021; 162(39): 1573–1578. Summary. Introduction: There is no clear recommendation for the optimal age to perform corrective surgery in adolescent idiopathic scoliosis. Fusion surgery is performed from the age of 11 to 50–60 years, with an average coronal plane correction efficiency of 63–83%. Objective: We aimed to evaluate the effectiveness of correction surgeries in three dimensions in adolescent idiopathic scoliosis. In addition, our objective was to examine the influence of the patient’s age on the correction. Methods: The study included 23 patients with adolescent idiopathic scoliosis (12 patients younger than 17 years, 11 patients older than 17 years). All patients underwent screw-derotation and spondylodesis and underwent EOS 2D/3D imaging before and after the operation, followed by sterEOS 3D reconstructions. The following parameters were calculated: Cobb degree, thoracic kyphosis, lumbar lordosis, apical vertebral rotation, maximal vertebral rotation. Differences between different age groups were examined by paired-sample t-test and Wilcoxon rank sum test. Results: The mean efficiency of correction surgeries was 78.2% in the coronal plane (from an average of 55.1 Cobb degrees to 12.0 Cobb degrees) and 56.7% in the axial plane (from an average of 21.0 degrees to 9.1 degrees). We achieved an average 79.2% reduction of Cobb angle in patients operated after the age of 17 years, which was 77.0% in the younger group (p = 0.614). Apical vertebral rotation correction was significantly less successful in the elderly group (mean 38.1%; from 21.8 degrees to 12.4 degrees) than in patients operated before the age of 17 years (mean 68.5%; from 20.2 degrees to 6.2 degrees; p = 0.016). Conclusion: We achieved scoliosis correction in line with the international publications. Nearly the same correction efficiency was observed between different age groups of patients in the coronal plane. However, vertebral rotation can be derotated more effectively before the age of 17 years. Orv Hetil. 2021; 162(39): 1573–1578.

scholarly journals EXPERIENCE IN APPLICATION OF UNIVERSAL DORSAL INSTRUMENTATION FOR SCOLIOSIS TREATMENT

2005 ◽  
pp. 046-049 ◽  
Author(s):  
Mukhammad Tablikhanovich Sampiev ◽  
Aleksandr Andreyevich Laka ◽  
Stepan Petrovich Balashov
Keyword(s):  
Surgical Treatment ◽  
Cobb Angle ◽  
Growth Restriction ◽  
Single Stage ◽  
Surgical Correction ◽  
Dorsal Instrumentation ◽  
Scoliosis Correction ◽  
Scoliosis Treatment ◽  
The Mean

Objective. The objective of the study was the development of optimal, i.e simple, safe, and effective instrumentation for treatment of adolescent and adult scoliotic deformities. Material and Methods. The paper presents the results of surgical treatment in 23 patients with thoracic and thoracolumbar scoliosis with application of novel dorsal instrumentation developed at the Chair of Traumatology and Orthopaedics of the Russian University of Peoples’ Friendship. Twenty three patients at the mean age of 15.6 years (range, 11–44 years) with Grade IV thoracic and thoracolumbar scoliosis were operated on. The smallest Cobb angle of deformation was 61°, the largest – 96°. Surgical correction of scoliosis was performed with application of universal dorsal instrumentation. The follow-up period was 1 year. Results. The correction of Grade IV deformation with Cobb angle from 61 to 70° was 85.2–91.8 %; with Cobb angle from 71 to 80° was 83.8–90.5 %. The curvature from 81 to 96° was corrected by 65.6–73 % by single-stage operation. Conclusion. The suggested universal instrumentation for spine scoliosis correction is a hi-tech technique. Its advantages are the simple and safe application, good correction in three planes of deformation, the possibility of use both in children and in adults, and the absence of spine growth restriction in children.

scholarly journals A re-evaluation of the effects of dual growing rods on apical vertebral rotation in patients with early-onset scoliosis and a minimum of two lengthening procedures: a CT-based study

2018 ◽  
Vol 22 (3) ◽  
pp. 306-312 ◽  
Author(s):  
Liang Xu ◽  
Yong Qiu ◽  
Zhonghui Chen ◽  
Benlong Shi ◽  
Xi Chen ◽  
...  
Keyword(s):  
Early Onset ◽  
Rank Correlation ◽  
Axial Rotation ◽  
Vertebral Rotation ◽  
Early Onset Scoliosis ◽  
Ct Scans ◽  
Growing Rods ◽  
Apical Vertebral Rotation ◽  
Initial Surgery

OBJECTIVEThis study aimed to evaluate the correction results of traditional dual growing rods (DGRs) on axial rotation using CT scans and to further explore the relationships between axial and torso deformities in patients with early-onset scoliosis (EOS).METHODSPatients with EOS who were treated with traditional DGRs between January 2006 and December 2014 were retrospectively reviewed. Plain radiographs were used to assess the degree of coronal and sagittal deformity. The apical vertebral rotation (AVR) and rib hump (RH) were measured on CT scans at the apical vertebra. Pearson or Spearman rank correlation analyses were used to analyze the associations between spinal and torso deformities.RESULTSA total of 27 patients (10 boys and 17 girls, average age 6.5 ± 1.7 years) were enrolled in this study. The average number of lengthenings per patient was 5.0 ± 1.9, with a mean follow-up duration of 52.9 ± 18.2 months. The apical vertebral translation, apical vertebral body–rib ratio (AVB-R), AVR, and RH parameters were significantly decreased after the initial surgery (p < 0.05) but showed notable progression at the latest follow-up evaluation (p < 0.05). The preoperative AVR and its correction after index surgery were significantly correlated with the preoperative values as well as with the corrections of the major Cobb angle, AVB-R, and RH. During the follow-up period, significant correlations were found between the deterioration of AVR and the AVB-R and also between the deterioration of AVR and the RH from the initial surgery to the latest follow-up.CONCLUSIONSSignificant AVR correction can be achieved by DGR techniques after the initial surgery. However, this technique weakly prevents the deterioration of AVR during the follow-up period.

Complications and radiographic correction in adult scoliosis following combined transpsoas extreme lateral interbody fusion and posterior pedicle screw instrumentation

2010 ◽  
Vol 28 (3) ◽  
pp. E7 ◽  
Author(s):  
Matthew J. Tormenti ◽  
Matthew B. Maserati ◽  
Christopher M. Bonfield ◽  
David O. Okonkwo ◽  
Adam S. Kanter
Keyword(s):  
Cobb Angle ◽  
Lumbar Lordosis ◽  
Interbody Fusion ◽  
Combined Approach ◽  
Radiographic Outcomes ◽  
Scoliosis Correction ◽  
Extreme Lateral Interbody Fusion ◽  
The Mean ◽  
Lateral Interbody

Object The authors recently used a combined approach of minimally invasive transpsoas extreme lateral interbody fusion (XLIF) and open posterior segmental pedicle screw instrumentation with transforaminal lumbar interbody fusion (TLIF) for the correction of coronal deformity. The complications and radiographic outcomes were compared with a posterior-only approach for scoliosis correction. Methods The authors retrospectively reviewed all deformity cases that were surgically corrected at the University of Pittsburgh Medical Center Presbyterian Hospital between June 2007 and August 2009. Eight patients underwent combined transpsoas and posterior approaches for adult degenerative thoracolumbar scoliosis. The comparison group consisted of 4 adult patients who underwent a posterior-only scoliosis correction. Data on intra- and postoperative complications were collected. The pre- and postoperative posterior-anterior and lateral scoliosis series radiographic films were reviewed, and comparisons were made for coronal deformity, apical vertebral translation (AVT), and lumbar lordosis. Clinical outcomes were evaluated by comparing pre- and postoperative visual analog scale scores. Results The median preoperative coronal Cobb angle in the combined approach was 38.5° (range 18–80°). Following surgery, the median Cobb angle was 10° (p < 0.0001). The mean preoperative AVT was 3.6 cm, improving to 1.8 cm postoperatively (p = 0.031). The mean preoperative lumbar lordosis in this group was 47.3°, and the mean postoperative lordosis was 40.4°. Compared with posterior-only deformity corrections, the mean values for curve correction were higher for the combined approach than for the posterior-only approach. Conversely, the mean AVT correction was higher in the posterior-only group. One patient in the posterior-only group required revision of the instrumentation. One patient who underwent the transpsoas XLIF approach suffered an intraoperative bowel injury necessitating laparotomy and segmental bowel resection; this patient later underwent an uneventful posterior-only correction of her scoliotic deformity. Two patients (25%) in the XLIF group sustained motor radiculopathies, and 6 of 8 patients (75%) experienced postoperative thigh paresthesias or dysesthesias. Motor radiculopathy resolved in 1 patient, but persisted 3 months postsurgery in the other. Sensory symptoms persisted in 5 of 6 patients at the most recent follow-up evaluation. The mean clinical follow-up time was 10.5 months for the XLIF group and 11.5 months for the posterior-only group. The mean visual analog scale score decreased from 8.8 to 3.5 in the XLIF group, and it decreased from 9.5 to 4 in the posterior-only group. Conclusions Radiographic outcomes such as the Cobb angle and AVT were significantly improved in patients who underwent a combined transpsoas and posterior approach. Lumbar lordosis was maintained in all patients undergoing the combined approach. The combination of XLIF and TLIF/posterior segmental instrumentation techniques may lead to less blood loss and to radiographic outcomes that are comparable to traditional posterior-only approaches. However, the surgical technique carries significant risks that require further evaluation and proper informed consent.

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