Preservation of thoracic kyphosis is critical to maintain lumbar lordosis in the surgical treatment of adolescent idiopathic scoliosis

Restoration of the sagittal alignment is one of the fundamental goals in scoliosis correction surgery. Having an increase in popularity of segmental spinal instrumentation, thoracic kyphosis [TK] is often sacrificed to achieve frontal and axial plane correction. Patients with a Lenke type 1 deformity underwent selective thoracic fusion [lowest instrumented vertebra of T12 or L1] using corrective segmental spinal instrumentation [Hook-Rod] and were followed up for 2 years. They were evaluated before and after operation for coronal and sagittal alignments using standing anteroposterior and lateral radiographs. There were 63 patients [21 male, 42 female] with a mean age of 15.8 +/- 2.1 years included to this study. TK reduction had significant correlation [P

prevalence of distal junctional kyphosis following posterior instrumentation and arthrodesis for adolescent idiopathic scoliosis

Distal junctional kyphosis [DJK] is a radiographic finding in patients that undergo spinal instrumentation and fusion, since there is an abrupt transition between fixed and mobile spinal segments.The true incidence of DJK is variable in literature and seems that has a multifactorial etiology. A consecutive series of 130 patients [mean age 15.6 years] with Adolescent Idiopathic Scoliosis who underwent posterior spinal fusion and instrumentation were evaluated by analyzing coronal and sagittal angulation and balance measurements from standing radiographs obtained pre-operatively, within 6 weeks post-operation, at two years postoperative and at the latest follow-up. There was 35 male and 95 female. The mean time of followup was 36 months. The incidence of DJK at latest follow-up was 6.9% [9 patients]. In DJK group, distal junctional angle from pre-operative of-12.5 lordosis [-30 to 0] reached to-5.5 [P=0.015] at 6 weeks postoperation and to-1.4 [-20 to 12] [P=0.000] at 2 years follow-up, with mean of 12.1 kyphotic change [10-20]. In non DJK group, distal junctional angle from pre-operative angle of-7.5 reached-8.1 at 2 years follow-up [P=0.43]. The mean age of DJK group at surgery was 17 years and for non-DJK group was 15.4 years [P=0.022]. Distal junctional kyphosis was less common in this study than previous reports and stabilized after two years. The magnitude of coronal cobb angles or multiplicity of coronal curves had no effect in developing DJK that may be prevented by incorporation of the first lordotic disc into the fusion construct

Results of milwaukee and boston braces with or without metal marker around pads in patients with idiopathic scoliosis

Bracing is the non-operative treatment of choice for adolescent idiopathic scoliosis [AIS] and careful application of pads on apical segment of curve is very important for correction. Control of pads' appropriate site in brace is not easy by clinical evaluation. Therefore, we decided to compare results of braces which for better control of pads by radiographs, metal marker inserted around pads with those without metal marker. We evaluated 215 consecutive cases [182 female, 33 male] of AIS with 342 major curves from 1993 to 2003. Mean initial age was, 13.2 +/- 1.8 years [9-16] and mean duration of follow-up was, 16.1 +/- 16.4 months [0-114] that treated by 4 type of brace; 89 with type 1[Milwaukee with metal pads], 87 with type 2 [Milwaukee with simple pads], 17 with type 3 [Boston with metal pads] and 22 with type 4[Boston with simple pads]. Cobb angle recorded at 5 stages [initial, best, wean, stop and final follow-up]. Mean initial Cobb was 36.2°, at stop stage, 35.2° and reached 38° at final follow-up. Overall, 21.3% improved, 42.2% were the same and 36.5% failed. Failure for braces type 1 to 4 were, 40.5%, 34%, 38% and 24% at final follow-up. A total of 59 patients [27.4%] underwent spinal fusion that for brace type 1 to 4, was, 33, 21, 2 and 3 patients respectively. From 16 cases with initial Cobb of 50°, at follow-up, 12 were >/= 50° or had spinal fusion. Correction of lumbar [P=0.008] and main thoracic curves [P=0.002] was better by Boston than Milwaukee, however, in general difference between 4 types of braces was not significant and metal marker had no significant effect on results. Two important predictors of brace failure were, initial curve magnitude and brace type, but using metal marker around pads had no effect in results. It seems that bracing did not alter the natural history of scoliosis in early Risser stages with large magnitude of initial curves. Insertion of metal marker around pads is easy and cheap way that facilitate control of pad sites well, so, we recommend to use