TY - JOUR
T1 - Differences in curve behavior after fusion in adolescent idiopathic scoliosis patients with open triradiate cartilages
AU - Sponseller, Paul D.
AU - Betz, Randal
AU - Newton, Peter O.
AU - Lenke, Lawrence G.
AU - Lowe, Tom
AU - Crawford, Alvin
AU - Sucato, Daniel
AU - Lonner, Barry
AU - Marks, Michelle
AU - Bastrom, Tracey
PY - 2009/4/15
Y1 - 2009/4/15
N2 - STUDY DESIGN.: Retrospective review. OBJECTIVE.: To compare the results of spinal fusion in patients with open triradiate cartilages (OTRC) and closed triradiate cartilages (CTRC). SUMMARY OF BACKGROUND DATA.: Patients with OTRC at the time of spinal fusion may be at increased risk of developing postoperative changes related to growth. METHODS.: From a database of patients with adolescent idiopathic scoliosis, we identified 44 patients with OTRC (mean age, 11.6 years) and 450 patients with CTRC (mean age, 15.6 years) and a minimum follow-up of 2 years. Patients in both groups were treated with anterior-only, posterior-only, or combined anterior and posterior spinal fusion; none had all-pedicle screw posterior instrumentation. RESULTS.: In the OTRC group, anterior or posterior instrumentation, but not the combined approach, resulted in a significant mean late increase in the main curve (4.4° and 7.3° vs. 0°, respectively; P = 0.002), an approach-related difference not seen in the CTRC group. Significantly more OTRC patients had proximal levels added on after surgery than did CTRC patients (18% vs. 8%, respectively; P = 0.02), and there was a trend toward this phenomenon distally (29% vs. 19%, respectively; P = 0.10). Proximal and distal junctional kyphosis was not significantly different between the 2 groups. Reoperation rate was 11% and 7% for OTRC and CTRC patients, respectively. For the selectively fused Lenke 1C curves in OTRC and CTRC patients, there was a trend in the uninstrumented lumbar curve toward a smaller lumbar curve before surgery (36° and 41°, respectively; P = 0.07) and a larger curve after surgery (27° and 24°, respectively; P = 0.07). CONCLUSION.: Patients with scoliosis and OTRC have a greater risk of adding-on proximally and of loss of correction with anterior-only instrumentation; they may also have less predictable lumbar correction from selective thoracic fusion. However, after combined surgery, they have results similar to those of more skeletally mature patients.
AB - STUDY DESIGN.: Retrospective review. OBJECTIVE.: To compare the results of spinal fusion in patients with open triradiate cartilages (OTRC) and closed triradiate cartilages (CTRC). SUMMARY OF BACKGROUND DATA.: Patients with OTRC at the time of spinal fusion may be at increased risk of developing postoperative changes related to growth. METHODS.: From a database of patients with adolescent idiopathic scoliosis, we identified 44 patients with OTRC (mean age, 11.6 years) and 450 patients with CTRC (mean age, 15.6 years) and a minimum follow-up of 2 years. Patients in both groups were treated with anterior-only, posterior-only, or combined anterior and posterior spinal fusion; none had all-pedicle screw posterior instrumentation. RESULTS.: In the OTRC group, anterior or posterior instrumentation, but not the combined approach, resulted in a significant mean late increase in the main curve (4.4° and 7.3° vs. 0°, respectively; P = 0.002), an approach-related difference not seen in the CTRC group. Significantly more OTRC patients had proximal levels added on after surgery than did CTRC patients (18% vs. 8%, respectively; P = 0.02), and there was a trend toward this phenomenon distally (29% vs. 19%, respectively; P = 0.10). Proximal and distal junctional kyphosis was not significantly different between the 2 groups. Reoperation rate was 11% and 7% for OTRC and CTRC patients, respectively. For the selectively fused Lenke 1C curves in OTRC and CTRC patients, there was a trend in the uninstrumented lumbar curve toward a smaller lumbar curve before surgery (36° and 41°, respectively; P = 0.07) and a larger curve after surgery (27° and 24°, respectively; P = 0.07). CONCLUSION.: Patients with scoliosis and OTRC have a greater risk of adding-on proximally and of loss of correction with anterior-only instrumentation; they may also have less predictable lumbar correction from selective thoracic fusion. However, after combined surgery, they have results similar to those of more skeletally mature patients.
KW - Fusion
KW - Scoliosis
KW - Triradiate cartilage
UR - http://www.scopus.com/inward/record.url?scp=67650312825&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=67650312825&partnerID=8YFLogxK
U2 - 10.1097/BRS.0b013e31819139ef
DO - 10.1097/BRS.0b013e31819139ef
M3 - Article
C2 - 19337136
AN - SCOPUS:67650312825
SN - 0362-2436
VL - 34
SP - 827
EP - 831
JO - Spine
JF - Spine
IS - 8
ER -