Apical wiring technique in surgical treatment of adolescent idiopathic scoliosis

The intermediate outcomes between lenke types

Weera Chaiyamongkol, Eric Otto Klineberg, Munish C. Gupta

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

STUDY DESIGN:: Retrospective cohort study of apical wiring technique for surgical treatment of adolescent idiopathic scoliosis patients. OBJECTIVE:: To evaluate the intermediate outcome of adolescent idiopathic scoliosis patients treated with apical wiring technique. SUMMARY OF BACKGROUND DATA:: Regarding surgical treatment for adolescent idiopathic scoliosis, there are reports of the superiority of coronal plane correction using all-screw constructs compared with all-hook or hybrid constructs. Major limitations of all-screw constructs are thoracic hypokyphosis and increased proximal junctional kyphosis. There are few reports about apical wiring technique outcomes and no reports of this surgical technique comparing Lenke types. METHODS:: Consecutive adolescent idiopathic scoliosis patients treated with apical wiring technique were analyzed. Inclusion criteria were patient 21 years old or younger, who underwent a posterior only surgical correction with a follow-up of at least 2 years. Radiographic data were analyzed according to the criteria given by Lenke and colleagues. The radiographic parameters included global balance, Cobb angle, curve flexibility, apical vertebral translation, tilt angle of lower instrumented vertebra, angle of caudal disk to the lower instrumented vertebra, thoracic kyphosis, lumbar lordosis, and proximal junctional angle preoperatively and postoperatively. RESULTS:: There was a significant improvement of Cobb angle in every Lenke type with an average correction of 74.6%. At latest follow-up, the average loss of correction was 3.5% (1.9 degrees). The greatest loss of correction for the minor curve of Lenke 2 was 14.1% (5.8 degrees). There was an improvement of thoracic kyphosis in hypokyphosis group (1.9-21.1 degrees; P<0.001) and hyperkyphosis group (49.8-33.2 degrees; P=0.001). Thoracic normokyphosis alignment was also preserved. No cases of abnormal proximal junctional kyphosis were noted in this cohort. CONCLUSIONS:: Apical wiring technique for surgical treatment of adolescent idiopathic scoliosis provides an average correction of 71.1% at 3.4 years of average follow-up with harmonious sagittal plane correction even with preexisting abnormal thoracic kyphosis.

Original languageEnglish (US)
JournalJournal of Spinal Disorders and Techniques
Volume26
Issue number1
DOIs
StatePublished - Feb 2013

Fingerprint

Kyphosis
Scoliosis
Thorax
Thoracic Vertebrae
Therapeutics
Lordosis
Spine
Cohort Studies
Retrospective Studies

Keywords

  • adolescent
  • apical wiring technique
  • hybrid construct
  • idiopathic scoliosis
  • pedicle screw construct
  • thoracic kyphosis

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Orthopedics and Sports Medicine

Cite this

@article{c1ed73bb789648179f8c1c1dd09e1cee,
title = "Apical wiring technique in surgical treatment of adolescent idiopathic scoliosis: The intermediate outcomes between lenke types",
abstract = "STUDY DESIGN:: Retrospective cohort study of apical wiring technique for surgical treatment of adolescent idiopathic scoliosis patients. OBJECTIVE:: To evaluate the intermediate outcome of adolescent idiopathic scoliosis patients treated with apical wiring technique. SUMMARY OF BACKGROUND DATA:: Regarding surgical treatment for adolescent idiopathic scoliosis, there are reports of the superiority of coronal plane correction using all-screw constructs compared with all-hook or hybrid constructs. Major limitations of all-screw constructs are thoracic hypokyphosis and increased proximal junctional kyphosis. There are few reports about apical wiring technique outcomes and no reports of this surgical technique comparing Lenke types. METHODS:: Consecutive adolescent idiopathic scoliosis patients treated with apical wiring technique were analyzed. Inclusion criteria were patient 21 years old or younger, who underwent a posterior only surgical correction with a follow-up of at least 2 years. Radiographic data were analyzed according to the criteria given by Lenke and colleagues. The radiographic parameters included global balance, Cobb angle, curve flexibility, apical vertebral translation, tilt angle of lower instrumented vertebra, angle of caudal disk to the lower instrumented vertebra, thoracic kyphosis, lumbar lordosis, and proximal junctional angle preoperatively and postoperatively. RESULTS:: There was a significant improvement of Cobb angle in every Lenke type with an average correction of 74.6{\%}. At latest follow-up, the average loss of correction was 3.5{\%} (1.9 degrees). The greatest loss of correction for the minor curve of Lenke 2 was 14.1{\%} (5.8 degrees). There was an improvement of thoracic kyphosis in hypokyphosis group (1.9-21.1 degrees; P<0.001) and hyperkyphosis group (49.8-33.2 degrees; P=0.001). Thoracic normokyphosis alignment was also preserved. No cases of abnormal proximal junctional kyphosis were noted in this cohort. CONCLUSIONS:: Apical wiring technique for surgical treatment of adolescent idiopathic scoliosis provides an average correction of 71.1{\%} at 3.4 years of average follow-up with harmonious sagittal plane correction even with preexisting abnormal thoracic kyphosis.",
keywords = "adolescent, apical wiring technique, hybrid construct, idiopathic scoliosis, pedicle screw construct, thoracic kyphosis",
author = "Weera Chaiyamongkol and Klineberg, {Eric Otto} and Gupta, {Munish C.}",
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language = "English (US)",
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T1 - Apical wiring technique in surgical treatment of adolescent idiopathic scoliosis

T2 - The intermediate outcomes between lenke types

AU - Chaiyamongkol, Weera

AU - Klineberg, Eric Otto

AU - Gupta, Munish C.

PY - 2013/2

Y1 - 2013/2

N2 - STUDY DESIGN:: Retrospective cohort study of apical wiring technique for surgical treatment of adolescent idiopathic scoliosis patients. OBJECTIVE:: To evaluate the intermediate outcome of adolescent idiopathic scoliosis patients treated with apical wiring technique. SUMMARY OF BACKGROUND DATA:: Regarding surgical treatment for adolescent idiopathic scoliosis, there are reports of the superiority of coronal plane correction using all-screw constructs compared with all-hook or hybrid constructs. Major limitations of all-screw constructs are thoracic hypokyphosis and increased proximal junctional kyphosis. There are few reports about apical wiring technique outcomes and no reports of this surgical technique comparing Lenke types. METHODS:: Consecutive adolescent idiopathic scoliosis patients treated with apical wiring technique were analyzed. Inclusion criteria were patient 21 years old or younger, who underwent a posterior only surgical correction with a follow-up of at least 2 years. Radiographic data were analyzed according to the criteria given by Lenke and colleagues. The radiographic parameters included global balance, Cobb angle, curve flexibility, apical vertebral translation, tilt angle of lower instrumented vertebra, angle of caudal disk to the lower instrumented vertebra, thoracic kyphosis, lumbar lordosis, and proximal junctional angle preoperatively and postoperatively. RESULTS:: There was a significant improvement of Cobb angle in every Lenke type with an average correction of 74.6%. At latest follow-up, the average loss of correction was 3.5% (1.9 degrees). The greatest loss of correction for the minor curve of Lenke 2 was 14.1% (5.8 degrees). There was an improvement of thoracic kyphosis in hypokyphosis group (1.9-21.1 degrees; P<0.001) and hyperkyphosis group (49.8-33.2 degrees; P=0.001). Thoracic normokyphosis alignment was also preserved. No cases of abnormal proximal junctional kyphosis were noted in this cohort. CONCLUSIONS:: Apical wiring technique for surgical treatment of adolescent idiopathic scoliosis provides an average correction of 71.1% at 3.4 years of average follow-up with harmonious sagittal plane correction even with preexisting abnormal thoracic kyphosis.

AB - STUDY DESIGN:: Retrospective cohort study of apical wiring technique for surgical treatment of adolescent idiopathic scoliosis patients. OBJECTIVE:: To evaluate the intermediate outcome of adolescent idiopathic scoliosis patients treated with apical wiring technique. SUMMARY OF BACKGROUND DATA:: Regarding surgical treatment for adolescent idiopathic scoliosis, there are reports of the superiority of coronal plane correction using all-screw constructs compared with all-hook or hybrid constructs. Major limitations of all-screw constructs are thoracic hypokyphosis and increased proximal junctional kyphosis. There are few reports about apical wiring technique outcomes and no reports of this surgical technique comparing Lenke types. METHODS:: Consecutive adolescent idiopathic scoliosis patients treated with apical wiring technique were analyzed. Inclusion criteria were patient 21 years old or younger, who underwent a posterior only surgical correction with a follow-up of at least 2 years. Radiographic data were analyzed according to the criteria given by Lenke and colleagues. The radiographic parameters included global balance, Cobb angle, curve flexibility, apical vertebral translation, tilt angle of lower instrumented vertebra, angle of caudal disk to the lower instrumented vertebra, thoracic kyphosis, lumbar lordosis, and proximal junctional angle preoperatively and postoperatively. RESULTS:: There was a significant improvement of Cobb angle in every Lenke type with an average correction of 74.6%. At latest follow-up, the average loss of correction was 3.5% (1.9 degrees). The greatest loss of correction for the minor curve of Lenke 2 was 14.1% (5.8 degrees). There was an improvement of thoracic kyphosis in hypokyphosis group (1.9-21.1 degrees; P<0.001) and hyperkyphosis group (49.8-33.2 degrees; P=0.001). Thoracic normokyphosis alignment was also preserved. No cases of abnormal proximal junctional kyphosis were noted in this cohort. CONCLUSIONS:: Apical wiring technique for surgical treatment of adolescent idiopathic scoliosis provides an average correction of 71.1% at 3.4 years of average follow-up with harmonious sagittal plane correction even with preexisting abnormal thoracic kyphosis.

KW - adolescent

KW - apical wiring technique

KW - hybrid construct

KW - idiopathic scoliosis

KW - pedicle screw construct

KW - thoracic kyphosis

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