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Pedicle screw versus hybrid posterior instrumentation for dystrophic neurofibromatosis scoliosis.

Abstract Surgical management of severe rigid dystrophic neurofibromatosis (NF) scoliosis is technically demanding and produces varying results. In the current study, we reviewed 9 patients who were treated with combined anterior and posterior fusion using different types of instrumentation (i.e., pedicle screw, hybrid, and all-hook constructs) at our institute.Between September 2001 and July 2010 at our institute, 9 patients received anterior release/fusion and posterior fusion with different types of instrumentation, including a pedicle screw construct (n = 5), a hybrid construct (n = 3), and an all-hook construct (n = 1). We compared the pedicle screw group with the hybrid group to analyze differences in preoperative curve angle, immediate postoperative curve reduction, and latest follow-up curve angle.The mean follow-up period was 9.5 ± 2.9 years. The average age at surgery was 10.3 ± 3.9 years. The average preoperative scoliosis curve was 61.3 ± 13.8°, and the average preoperative kyphosis curve was 39.8 ± 19.7°. The average postoperative scoliosis and kyphosis curves were 29.7 ± 10.7° and 21.0 ± 13.5°, respectively. The most recent follow-up scoliosis and kyphosis curves were 43.4 ± 17.3° and 29.4 ± 18.9°, respectively. There was no significant difference in the correction angle (either coronal or sagittal), and there was no significant difference in the loss of sagittal correction between the pedicle screw construct group and the hybrid construct group. However, the patients who received pedicle screw constructs had significantly less loss of coronal correction (P < .05). Two patients with posterior instrumentation, one with an all-hook construct and the other with a hybrid construct, required surgical revision because of progression of deformity.It is difficult to intraoperatively correct dystrophic deformity and to maintain this correction after surgery. Combined anterior release/fusion and posterior fusion using either a pedicle screw construct or a hybrid construct provide similar curve corrections both sagittally and coronally. After long-term follow-up, sagittal correction was maintained with both constructs. However, patients treated with posterior instrumentation using pedicle screw constructs had significantly less loss of coronal correction.
PMID
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Authors

Mayor MeshTerms

Pedicle Screws

Keywords
Journal Title medicine
Publication Year Start




PMID- 28562548
OWN - NLM
STAT- MEDLINE
DA  - 20170531
DCOM- 20170630
LR  - 20170630
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 22
DP  - 2017 Jun
TI  - Pedicle screw versus hybrid posterior instrumentation for dystrophic
      neurofibromatosis scoliosis.
PG  - e6977
LID - 10.1097/MD.0000000000006977 [doi]
AB  - Surgical management of severe rigid dystrophic neurofibromatosis (NF) scoliosis
      is technically demanding and produces varying results. In the current study, we
      reviewed 9 patients who were treated with combined anterior and posterior fusion 
      using different types of instrumentation (i.e., pedicle screw, hybrid, and
      all-hook constructs) at our institute.Between September 2001 and July 2010 at our
      institute, 9 patients received anterior release/fusion and posterior fusion with 
      different types of instrumentation, including a pedicle screw construct (n = 5), 
      a hybrid construct (n = 3), and an all-hook construct (n = 1). We compared the
      pedicle screw group with the hybrid group to analyze differences in preoperative 
      curve angle, immediate postoperative curve reduction, and latest follow-up curve 
      angle.The mean follow-up period was 9.5 +/- 2.9 years. The average age at surgery
      was 10.3 +/- 3.9 years. The average preoperative scoliosis curve was 61.3 +/-
      13.8 degrees , and the average preoperative kyphosis curve was 39.8 +/- 19.7
      degrees . The average postoperative scoliosis and kyphosis curves were 29.7 +/-
      10.7 degrees and 21.0 +/- 13.5 degrees , respectively. The most recent follow-up 
      scoliosis and kyphosis curves were 43.4 +/- 17.3 degrees and 29.4 +/- 18.9
      degrees , respectively. There was no significant difference in the correction
      angle (either coronal or sagittal), and there was no significant difference in
      the loss of sagittal correction between the pedicle screw construct group and the
      hybrid construct group. However, the patients who received pedicle screw
      constructs had significantly less loss of coronal correction (P &lt; .05). Two
      patients with posterior instrumentation, one with an all-hook construct and the
      other with a hybrid construct, required surgical revision because of progression 
      of deformity.It is difficult to intraoperatively correct dystrophic deformity and
      to maintain this correction after surgery. Combined anterior release/fusion and
      posterior fusion using either a pedicle screw construct or a hybrid construct
      provide similar curve corrections both sagittally and coronally. After long-term 
      follow-up, sagittal correction was maintained with both constructs. However,
      patients treated with posterior instrumentation using pedicle screw constructs
      had significantly less loss of coronal correction.
FAU - Wang, Jr-Yi
AU  - Wang JY
AD  - aDepartment of Orthopedic Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei
      bDepartment of Orthopedic Surgery, Chang Gung Memorial Hospital, Chang Gung
      University College of Medicine cBone and Joint Research Center, Chang Gung
      Memorial Hospital, Taoyuan, Taiwan.
FAU - Lai, Po-Liang
AU  - Lai PL
FAU - Chen, Wen-Jer
AU  - Chen WJ
FAU - Niu, Chi-Chien
AU  - Niu CC
FAU - Tsai, Tsung-Ting
AU  - Tsai TT
FAU - Chen, Lih-Huei
AU  - Chen LH
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Observational Study
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
SB  - AIM
SB  - IM
MH  - Adolescent
MH  - Child
MH  - Child, Preschool
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Kyphosis/diagnostic imaging/surgery
MH  - Male
MH  - Neurofibromatosis 1/diagnostic imaging/*surgery
MH  - *Pedicle Screws
MH  - Retrospective Studies
MH  - Scoliosis/diagnostic imaging/*surgery
MH  - Spinal Fusion/*instrumentation
MH  - Thoracic Vertebrae/diagnostic imaging/surgery
MH  - Treatment Outcome
PMC - PMC5459713
EDAT- 2017/06/01 06:00
MHDA- 2017/07/01 06:00
CRDT- 2017/06/01 06:00
AID - 10.1097/MD.0000000000006977 [doi]
AID - 00005792-201706020-00024 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Jun;96(22):e6977. doi: 10.1097/MD.0000000000006977.