Fusionless All-Pedicle Screws for Posterior Deformity Correction in AIS Immature Patients Permit the Restoration of Normal Vertebral Morphology and Removal of the Instrumentation Once Bone Maturity Is Reached
The aim of this study was to report the restoration of normal vertebral morphology and the absence of curve progression after the removal of instrumentation in AIS patients that underwent posterior correction of the deformity by a common all-screws construct without fusion. A series of 36 AIS immatu...
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| Format: | Article |
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MDPI AG
2023-03-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/6/2408 |
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| author | Jesús Burgos Gonzalo Mariscal Luis Miguel Antón-Rodrigálvarez Ignacio Sanpera Eduardo Hevia Vicente García Carlos Barrios |
| author_facet | Jesús Burgos Gonzalo Mariscal Luis Miguel Antón-Rodrigálvarez Ignacio Sanpera Eduardo Hevia Vicente García Carlos Barrios |
| author_sort | Jesús Burgos |
| collection | DOAJ |
| description | The aim of this study was to report the restoration of normal vertebral morphology and the absence of curve progression after the removal of instrumentation in AIS patients that underwent posterior correction of the deformity by a common all-screws construct without fusion. A series of 36 AIS immature patients (Risser 3 or less) were included in the study. Instrumentation was removed once the maturity stage was complete (Risser 5). The curve correction was assessed pre- and postoperatively, before instrumentation removal, directly post-removal, and more than two years after instrumentation was removed. Epiphyseal vertebral growth modulation was assessed by the coronal wedging ratio (WR) at the apical level of the main curve (MC). The mean preoperative coronal Cobb was corrected from 53.7° ± 7.5 to 5.5° ± 7.5° (89.7%) at the immediate postop. After implant removal (31.0 ± 5.8 months), the MC was 13.1°. T5–T12 kyphosis showed significant improvement from 19.0° before curve correction to 27.1° after implant removal (<i>p</i> < 0.05). Before surgery, the WR was 0.71 ± 0.06, and after removal, 0.98 ± 0.08 (<i>p</i> < 0.001). At the end of the follow-up, the mean sagittal range of motion (ROM) of the T12-S1 segment was 51.2 ± 21.0°. The SRS-22 scores improved from 3.31 ± 0.25 preoperatively to 3.68 ± 0.25 at the final assessment (<i>p</i> < 0.001). In conclusion, a fusionless posterior approach using common all-pedicle screws correctly constructed satisfactory scoliotic main curves and permitted the removal of instrumentation once bone maturity was reached. The final correction was highly satisfactory, and an acceptable ROM of the previously lower instrumented segments was observed. |
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| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-11T06:21:49Z |
| publishDate | 2023-03-01 |
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| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-1c1a5b5b037b44dd877e21237a2aa8372023-11-17T11:52:27ZengMDPI AGJournal of Clinical Medicine2077-03832023-03-01126240810.3390/jcm12062408Fusionless All-Pedicle Screws for Posterior Deformity Correction in AIS Immature Patients Permit the Restoration of Normal Vertebral Morphology and Removal of the Instrumentation Once Bone Maturity Is ReachedJesús Burgos0Gonzalo Mariscal1Luis Miguel Antón-Rodrigálvarez2Ignacio Sanpera3Eduardo Hevia4Vicente García5Carlos Barrios6Spine Unit, Hospital Viamed Fuensanta, 28027 Madrid, SpainSchool of Doctorate, Valencia Catholic University, 46001 Valencia, SpainPediatric Orthopedics, Ramon y Cajal Hospital, 28034 Madrid, SpainPediatric Orthopedics, Hospital Son Espases, 07198 Palma de Mallorca, SpainSpine Unit, Hopsital La Fraternidad-Muprespa, 28036 Madrid, SpainSección de Cirugía de Columna, Hospital Universitario Araba, 01009 Vitoria, SpainInstitute for Research on Musculoskeletal Disorders, Valencia Catholic University, 46001 Valencia, SpainThe aim of this study was to report the restoration of normal vertebral morphology and the absence of curve progression after the removal of instrumentation in AIS patients that underwent posterior correction of the deformity by a common all-screws construct without fusion. A series of 36 AIS immature patients (Risser 3 or less) were included in the study. Instrumentation was removed once the maturity stage was complete (Risser 5). The curve correction was assessed pre- and postoperatively, before instrumentation removal, directly post-removal, and more than two years after instrumentation was removed. Epiphyseal vertebral growth modulation was assessed by the coronal wedging ratio (WR) at the apical level of the main curve (MC). The mean preoperative coronal Cobb was corrected from 53.7° ± 7.5 to 5.5° ± 7.5° (89.7%) at the immediate postop. After implant removal (31.0 ± 5.8 months), the MC was 13.1°. T5–T12 kyphosis showed significant improvement from 19.0° before curve correction to 27.1° after implant removal (<i>p</i> < 0.05). Before surgery, the WR was 0.71 ± 0.06, and after removal, 0.98 ± 0.08 (<i>p</i> < 0.001). At the end of the follow-up, the mean sagittal range of motion (ROM) of the T12-S1 segment was 51.2 ± 21.0°. The SRS-22 scores improved from 3.31 ± 0.25 preoperatively to 3.68 ± 0.25 at the final assessment (<i>p</i> < 0.001). In conclusion, a fusionless posterior approach using common all-pedicle screws correctly constructed satisfactory scoliotic main curves and permitted the removal of instrumentation once bone maturity was reached. The final correction was highly satisfactory, and an acceptable ROM of the previously lower instrumented segments was observed.https://www.mdpi.com/2077-0383/12/6/2408fusionless techniqueposterior instrumentationadolescent idiopathic scoliosisvertebral modulationpedicle screw stabilizationcoronal wedging ratio |
| spellingShingle | Jesús Burgos Gonzalo Mariscal Luis Miguel Antón-Rodrigálvarez Ignacio Sanpera Eduardo Hevia Vicente García Carlos Barrios Fusionless All-Pedicle Screws for Posterior Deformity Correction in AIS Immature Patients Permit the Restoration of Normal Vertebral Morphology and Removal of the Instrumentation Once Bone Maturity Is Reached Journal of Clinical Medicine fusionless technique posterior instrumentation adolescent idiopathic scoliosis vertebral modulation pedicle screw stabilization coronal wedging ratio |
| title | Fusionless All-Pedicle Screws for Posterior Deformity Correction in AIS Immature Patients Permit the Restoration of Normal Vertebral Morphology and Removal of the Instrumentation Once Bone Maturity Is Reached |
| title_full | Fusionless All-Pedicle Screws for Posterior Deformity Correction in AIS Immature Patients Permit the Restoration of Normal Vertebral Morphology and Removal of the Instrumentation Once Bone Maturity Is Reached |
| title_fullStr | Fusionless All-Pedicle Screws for Posterior Deformity Correction in AIS Immature Patients Permit the Restoration of Normal Vertebral Morphology and Removal of the Instrumentation Once Bone Maturity Is Reached |
| title_full_unstemmed | Fusionless All-Pedicle Screws for Posterior Deformity Correction in AIS Immature Patients Permit the Restoration of Normal Vertebral Morphology and Removal of the Instrumentation Once Bone Maturity Is Reached |
| title_short | Fusionless All-Pedicle Screws for Posterior Deformity Correction in AIS Immature Patients Permit the Restoration of Normal Vertebral Morphology and Removal of the Instrumentation Once Bone Maturity Is Reached |
| title_sort | fusionless all pedicle screws for posterior deformity correction in ais immature patients permit the restoration of normal vertebral morphology and removal of the instrumentation once bone maturity is reached |
| topic | fusionless technique posterior instrumentation adolescent idiopathic scoliosis vertebral modulation pedicle screw stabilization coronal wedging ratio |
| url | https://www.mdpi.com/2077-0383/12/6/2408 |
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