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Texas Scottish Rite Hospital instrumentation for correction of idiopathic scoliosis: short-term results

  • P. Korovessis
  • A. Baikousis
  • M. Stamatakis
  • G. Petsinis
  • Z. Papazisis
Original Articles
  • 53 Downloads

Summary

In this prospective study 27 consecutive patients of an average age of 20±8 years suffering from idiopathic scoliosis were operated on using the Texas Scottish Rite Hospital (TSRH) instrumentation in the period from 1992 to 1995 and were evaluated at a minimum follow-up of 26 months postoperatively. Curvature correction, derotation of the apical vertebra, frontal and sagittal trunk balance, and L3–L4 and L4–L5 disc-space wedging were evaluated prepostoperatively and at the maximum follow-up of 54 months. The average correction of the thoracic and lumbar scolioses that was obtained immediately postoperatively averaged 41% and 51% respectively. An average 2–4° and 4–5° loss of correction was dependent on King type in the thoracic and lumbar scoliotic curves respectively was observed at the longest follow-up. Thoracic kyphosis and lumbar lordosis did not significantly change. No significant derotation of thoracic and lumbar apical vertebral rotation was achieved by TSRH but the preoperatively laterally shifted apical vertebra was translated by TSRH instrumentation towards the midline (p<0.001). The position of the T1, and C7 vertebrae in the sagital frontal plane was not significantly changed by TSRH instrumentation postoperatively. The preoperative wedging of the intervertebral spaces L3–L4 and L4–L5 was simultaneously significantly (p<0.01) reduced by TSRH with subsequent horizontalization of the L3, L4 and L5 vertebrae. No trunk decompensation, neurologic complications, infection or pseudarthroses occurred. Lumbar hook dislodgment occurred in the early post-operative period in two patients because of insufficient TSRH rod contouring at the beginning of our learning curve. TSRH is a safe instrumentation that corects idiopathic scoliosis satisfactorily, maintains frontal and sagittal vertebral balance by translating the apical vertebra towards the midline and simultaneously correcting the lowermost lumbar vertebral tilting without associated infection, neurologic complications or decompensation.

Key words

Texas Scottish Rite Hospital Idiopathic scoliosis 

L’instrumentation Texas Scottish Rite Hospital pour la correction des scolioses idiopathiques

Résumé

Les auteurs présentent une étude prospective, portant sur une série consécutive de 27 patients d’un âge moyen de 20 ±8 ans, ayant bénéficié d’une instrumentation chirurgicale de type Texas Scottish Rite Hospital (TSRH) pour scoliose idiopathique pendant la période de 1992 à 1995, revus avec un recul post-opératoire d’au moins 26 mois.

La correction angulaire des courbures, la dérotation de la vertèbre sommet, l’équilibre dans le plan frontal et sagittal et l’évolution de la forme des disques L3–L4 et L4–L5 ont été analysés en pré et post-opératoire, avec un recul maxima de 54 mois. La correction angulaire moyenne obtenue en post-opératoire immédiat était de 41 % pour la courbure thoracique et 51 % pour la courbure lombaire. Au contrôle final, la perte moyenne de correction par rapport au résultat post-opératoire immédiat était de 2 à 4° en thorracique et 4 à 5° en lombaire. L’intervention n’a pas occasionné de modification significative de la cyphose dorsale et de la lordose lombaire. De même, l’instrumentation TSRH n’a pas permis d’obtenir de réel effet de dérotation de la vertèbre sommet, ni en thoracique, ni en lombaire; par contre la vertèbre apicale qui était translatée latéralement en pré-opératoire a été bien ramenée vers la ligne médiane sous l’effet de l’instrumentation (p<0.0001). La situation des vertèbres C7 et T1 n’a pas été significativement modifiée par l’instrumentation, ni dans le plan frontal, ni dans le plan sagittal. la cuméiformisation pré-opératoire des disques l3–L4 et L4–L5 a été sensiblement réduite (p<0.01) par le TSRH avec horizontalisation simultanée des vertèbres L3, L4 et L5. L’analyse des résultats n’a objectivé aucun déséquilibre du tronc, ni complication neurologique, infectieuse ou pseudarthrose. Un démontage de crochet lombaire s’est produit en post-opératoire immédiat chez deux patients en raison d’un modelage insuffisant de la tite au début de la période d’apprentissage des auteurs.

En conclusion, le TSHR est une instrumentation fiable et sûre pour obtenir une correction satisfaisante des scolioses idiopathiques et pour assurer le maintien d’un bon équilibre dans le plan frontal et sagittal grâce à la translation de la vertèbre apicale vers la ligne médiane et à la correction simultanée de l’inclinaison de la vertèbre lombaire inférieure.

Mots-clés

Scolioses idiopathiques Traitement chirurgical 

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Copyright information

© Springer-Verlag 2000

Authors and Affiliations

  • P. Korovessis
    • 1
  • A. Baikousis
    • 1
  • M. Stamatakis
    • 1
  • G. Petsinis
    • 1
  • Z. Papazisis
    • 1
  1. 1.Spine UnitGeneral Hospital “Agios Andreas”PatrasGreece

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