Comparison of different strategies on three-dimensional correction of AIS: which plane will suffer?
Tom P. Schlösser, Kariman Abelin-Genevois, Jelle Homans, Saba Pasha, Moyo Kruyt, Pierre Roussouly, Suken A. Shah, René M. Castelein
March 2021, Volume 30, Issue 3, pp 645 - 652 Original Article Read Full Article 10.1007/s00586-020-06659-2
First Online: 23 December 2020
There are distinct differences in strategy amongst experienced surgeons from different ‘scoliosis schools’ around the world. This study aims to test the hypothesis that, due to the 3-D nature of AIS, different strategies can lead to different coronal, axial and sagittal curve correction.
Consecutive patients who underwent posterior scoliosis surgery for primary thoracic AIS were compared between three major scoliosis centres (n = 193). Patients were treated according to the local surgical expertise: Two centres perform primarily an axial apical derotation manoeuvre (centre 1: high implant density, convex rod first, centre 2: low implant density, concave rod first), whereas centre 3 performs posteromedial apical translation without active derotation. Pre- and postoperative shape of the main thoracic curve was analyzed using coronal curve angle, apical rotation and sagittal alignment parameters (pelvic incidence and tilt, T1–T12, T4-T12 and T10-L2 regional kyphosis angles, C7 slope and the level of the inflection point). In addition, the proximal junctional angle at follow-up was compared.
Pre-operative coronal curve magnitudes were similar between the 3 cohorts and improved 75%, 70% and 59%, from pre- to postoperative, respectively (P
Curve correction by derotation may lead to thoracolumbar lordosis and therefore higher risk for proximal junctional kyphosis. Focus on sagittal plane by posteromedial translation, however, results in more residual coronal and axial deformity.
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