Efficacy of anterior and posterior multilevel vertebrotomy in adolescents with Len- ke type 1 and 2 idiopathic scoliosis operated on using pedicle screw fixation with various implant density

• Main Authors: Alexandr S. Vasyura, Elena V. Gubina, Mikhail V. Mikhaylovskiy
• Format: Article
• Language: English
• Published: Ministry of Health of Russian Federation, Federal State Budgetary Institution "Novosibirsk Research Institute of Traumatology and Orthopaedics n.a. Ya.L. Tsivyan" 2020-09-01
• Series: Хирургия позвоночника
• Subjects: adolescent idiopathic scoliosis; pedicle screw fixation; anterior release; posterior release
• Online Access: https://www.spinesurgery.ru/jour/article/view/1724/1712

Objective. To analyze the efficacy of posterior and anterior multilevel vertebrotomy in adolescents with Lenke type 1 and 2 idiopathic scoliosis operated on using pedicle screw and hybrid instrumentation with varying implant density (ID). Material and Methods. The immediate and long-term results of surgical treatment of 271 adolescents with Lenke type 1 or 2 idiopathic scoliosis (with primary thoracic curve) operated on using one of three surgical techniques: instrumental correction and posterior fusion (n = 212), the same technique supplemented with discectomy and interbody fusion (n = 30), and that with posterior vertebrotomy (n = 29). In all three groups, the relationship between age, initial Cobb angle, mobility, ID, and treatment outcomes assessed using X-ray data and SRS-24 questionnaire was studied, including the construction of linear regression models. Results. In all groups, significant predictors of deformity correction were initial Cobb angle and ID, while the indicators of mobility and age did not demonstrate significance. The study showed no effect of anterior and posterior vertebrotomy on the magnitude of correction and its maintenance in the long-term period, as well as on the patient-reported outcomes (SRS-24). The combination of all indicators in the model explains 51 % to 74 % of the achieved correction variability. The explanatory power of the ID for the achieved correction is at least three times less than the explanatory power of the initial Cobb angle. Conclusion. Anterior discectomy with interbody fusion and posterior vertebrotomy as methods of spine release in surgery for adolescent idiopathic scoliosis do not provide additional correction of the thoracic scoliosis. Herein, the number of anchoring elements used for polysegmental fixation (implant density) does not play a role in maintaining the corrective effect.