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  • Title: Computed tomography evaluation of rotation correction in adolescent idiopathic scoliosis: a comparison of an all pedicle screw construct versus a hook-rod system.
    Author: Asghar J, Samdani AF, Pahys JM, D'andrea LP, Guille JT, Clements DH, Betz RR, Harms Study Group.
    Journal: Spine (Phila Pa 1976); 2009 Apr 15; 34(8):804-7. PubMed ID: 19365248.
    Abstract:
    STUDY DESIGN: Retrospective review with historical cohort. OBJECTIVE: Our study measures axial rotation of the apical vertebral bodies of patients with adolescent idiopathic scoliosis treated with an all pedicle screw (APS) construct versus a hook-rod (HR) construct using computed tomography (CT). SUMMARY OF BACKGROUND DATA: Ecker et al (Spine 1988;13:1141-4) observed a 22% derotation of the apical vertebrate of the thoracic spine and 33% of the apical vertebra of the lumbar spine when using an HR system (CD instrumentation). More recently Lee et al (Spine 2004;29:343-9) reported 42.5% derotation of the apical vertebra (both thoracic and lumbar) in a series of APS constructs. Currently, there is no comparison series reported between the 2 types of constructs. METHODS: From a database of 193 patients with adolescent idiopathic scoliosis and posterior spinal fusions, 32 patients were identified as having all APS constructs with pre- and postoperative CT scans. This cohort of patients was compared with a historical published cohort of patients treated with HR constructs by Ecker et al (Spine 1988;13:1141-4) Comparison of the groups showed no statistically significant differences for age and preoperative Cobb angle of the main curve (P > 0.05); however, there was a statistically significant difference (P < 0.05) in postoperative correction values. The apical vertebral rotation for the major curve was measured from the pre- and postoperative axial CT using the methods described by Aaro and Dahlborn (Spine 1981;6:460-7). RESULT: The average preoperative rotation was similar between the 2 groups (thoracic: HR = 22.6, APS = 21.3, P = 0.6; lumbar: HR = 19.4, APS = 20.6, P = 0.7). The postoperative correction had a significant difference (thoracic: HR = 16, APS = 8.5, P = 0.015; lumbar: HR = 13.4, APS = 7.0, P = 0.032). The percent correction of the apical vertebrae showed a significant difference, with 22% correction in the HR group and 60% in APS group (P < 0.001). CONCLUSION: Our study finds axial rotation correction using APSs and a direct vertebral body derotation technique was significantly greater than that obtained with the HR construct.
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