Posterior Approach for Lumbar and Thoracolumbar Adolescent Idiopathic Curves: Posterior Shortening and Pedicle Screws

· (c - Depuy Acromed)

Miami Childrens Hospital, Miami, FL, USA

INTRODUCTION:
The anterior approach for lumbar and thoracolumbar deformities has been advocated for many years, claiming increased correction and fewer levels fused. The anterior kyphosing effect may be lessened with the use of solid rods and structural interbody grafts.

PURPOSE:
The hypothesis of this study is that the combination of wide posterior lumbar release and only pedicle screw instrumentation produces equal or improved results compared to the anterior approach.

METHODS AND MATERIALS:
All patients are consecutive for the diagnosis and surgery, and were prospectively collected and followed. Inclusion required the diagnosis of adolescent idiopathic scoliosis with curve type Lenke 5 or 6, or Lenke 3-C. The thoracolumbar or lumbar segments received identical surgical treatment: 1. Only the levels of the Cobb measurement were fused and instrumented. 2. Wide posterior release (interspinous ligament, ligamentum flavum, and facet excision from both inside and outside the canal). 3. Pedicle screws were the only spinal anchor in the thoracolumbar or lumbar segments. 4. Minimum 2 year follow-up.

RESULTS:
Demographics of study group.

Of 62 patients started (1 lost), 61 remained. 40 were Lenke 5 or 6, 21 were 3C

DISCUSSION:
The 80% coronal plane correction and the 81% horizontalization of lowest instrumented vertebra exceed all reported studies on anterior approach to this deformity. Maintenance lordosis in excess thirty degrees is likewise unmatched by approach. ability attain maintain excellent sagittal with demonstrated short posterior procedure confined Cobb measurement Lenke 5 6 curves, lumbar segment 3C curves.