Adult Scoliosis Correction: Clinical and Radiographic Comparison of Techniques

Introduction: This study compares outcomes in patients with adult scoliosis treated with the new direct vertebral translation technique compared to patients treated with rod derotation and in situ bending.

Methods: Sixty consecutive adult scoliosis patients age55(20-80yrs) underwent posterior correction by one surgeon, followed 4yrs(2-11yrs). Seventeen used rod derotation and in situ rod bending. Forty-three used direct vertebral translation by slowly pulling the spine to a contoured rod via pivoting reduction posts attached to screws, simultaneously correcting both coronal and sagittal deformity. Two patients from each group required osteotomies. Anterior surgery was required in 15/17 control and 39/43 direct translation patients. Oswestry, VAS, pain medication use, and work status were followed along with radiographs. Clinical and radiographic results were analyzed by curve type.

Results: The direct translation group curves of 49 (range17-83 ) corrected 72% to 14 (4-40 ) was better (P <0 .01) than control group curves of 55°(25-84°) corrected 48% to 29°(10-59°). Idiopathic scoliosis 58°(43-83°) in the translation 69% 18°(7-40°) compared 49% correction group. Correction vs by curve type was: degenerative 67%vs 49%, thoracic 70%vs51%, thoracolumbar 81%vs44%, lumbar 74%vs67% , double major 62%vs34% . Control complications included 3 nonunions (17%), 2 screw loosening (11%), 1 broken rod, infection. The had 4 (9%), infections, no pullout. Eleven 14 patients working pre-op returned work. Oswestry and VAS score improvements were not statistically different between groups at years.

Conclusions: This study shows statistically improved correction of adult scoliosis by direct vertebral translation using screws with pivoting reduction posts compared to other techniques. The most dramatic improvement was seen in patients with thoracolumbar and lumbar scoliosis. The technique appears to be very promising in patients with adult scoliosis.