|
THE THREE DIMENSIONAL
EVOLUTION OF SCOLIOTIC CURVATURE DURING INSTRUMENTATION WITHOUT FUSION
IN IMMATURE PATIENTS
Emre Acaroglu,
Ahmet Alanay,
Muharrem Yazici,
Adil Surat Sihhiye,
Ankara, Turkey
PURPOSE:
To evaluate the evolution of scoliotic curves until definitive fusion
in immature patients that had undergone single rod distraction instrumentation
without fusion (SCR).
PATIENTS AND METHODS:
Twelve patients who had been followed till definitive fusion were retrospectively
evaluated. Patients were evaluated for any changes in the magnitude of
their deformities in frontal, sagittal and transverse planes. Average
patient age was 5.8±2.4 years at the time of SCR, and 11.3±1.6 years at
definitive surgery. Average follow–up was 5.5±1.9 (2–8,5) years.
RESULTS:
It was seen that average number of lengthening operations per patient
was 4.6±1.8 (2–7), number of all operations per patient was 7.1±2.6 (4–13).
Average number of complications per patient was 1.9±2.2 (0–6). Average
time spent in hospital was 104±69 (30–262) days. A summary of results
can be seen on Table 1.
|
Ave±SD
(range)(0)
|
Pre–SCR
|
Pre–def.surg
|
% change
during SCR
|
Post–def.surg
|
|
Fro. Cobb
|
58.7±12.2 (40–90)
|
59.6±12.1 (45–78)
|
7.4±18.8 (–27 – 35)
|
34±7.7 (22–45)
|
|
Apical rot.
|
20.2±7.3 (10–35)
|
33.2±5.2 (25–42)
|
42.6±18.3 (0–67)
|
|
|
Th. Kyph.
|
30.1±10.7 (10–48)
|
40.9±9.8 (20–52)
|
|
41.8±10.9 (25–55)
|
|
Lum. Lord.
|
39.7±11.6 (24–65)
|
47.8±16.3 (18–80)
|
|
50.3±7.1 (40–60)
|
Average curve flexibility index was 46.7±10
at the time of SCR. At definitive surgery an average of 3.3±2.7 posterior
osteotomies were required so as to obtain any flexibility, because of
facet ankylosis.
DISCUSSION:
Our findings demonstrate that, the curves were essentially unchanged in
the frontal plane during the period of lengthenings. The sagittal curves
remained mostly within the limits of normal, but there was an alarming
increase in rotation. Curves could be corrected to the level obtained
at first SCR operation at the time of definitive surgery. Definitive surgery
following SCR is very complex and requires facet osteotomies at multiple
levels, yielding only 41.4% correction. It was concluded that, SCR with
a single distraction rod was effective in preserving the frontal deformity
for an average of 5.5 years, but was ineffective in controlling any increases
in transverse plane deformity.
|
|