• Kohei Goshi, Oheneba Boachie-Adjei, Cheryl Moore, and Makoto Nishiyama.
• Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
• Spine J. 2004 Mar 1;4(2):192-201.

Background ContextPostoperative coronal decompensation in selective thoracic fusion was reported with derotation maneuvers when using the Cotrel-Dubousset (CD) system. Isola instrumentation is a multiple anchor system that corrects spine deformity with segmental vertebral translation to a predetermined contoured longitudinal member.PurposeTo evaluate the efficacy of translational corrective techniques using Isola instrumentation in thoracic fusion for adolescent and adult idiopathic scoliosis patients.Study Design/SettingThis is a retrospective review of adolescent and adult patients with idiopathic scoliosis who underwent posterior thoracic fusion using translational corrective techniques with Isola instrumentation.Patient SampleTwenty-two patients (14 adolescents with idiopathic scoliosis, 8 adults with scoliosis) who underwent posterior thoracic fusion using translational corrective techniques were evaluated.Outcome MeasuresThe charts, radiographs and self-assessment questionnaire were reviewed.MethodsComparative analysis was done between patients who had Lenke Type A curves (Group 1) and Lenke Type B or C curves (Group 2) for both adolescent and adult scoliosis groups.ResultsThe mean follow-up was 54 months (range, 33 to 80 months). The mean preoperative Cobb angle of thoracic and lumbar curves in all 22 patients was 48 degrees (range, 34 to 64 degrees) and 31 degrees (range, 20 to 46 degrees), respectively. Postoperative measurements were 16 degrees (range, 0 to 28 degrees) for thoracic and 13 degrees (range, 2 to 25 degrees) for lumbar (67% thoracic and 60% lumbar correction) in Group 1, and 19 degrees (range, 1 to 33 degrees) for thoracic and 12 degrees (1 to 21 degrees) for lumbar at latest follow-up (61% thoracic and 61% lumbar correction) in Group 2. There was no difference in the final correction of the lumbar curves between Groups 1 (64%) and 2 (58%), although the Cobb angle in Group 2 was larger. Radiographic coronal decompensation occurred in only one patient in Group 2, who remained asymptomatic and required no further treatment. Clinical outcome assessment showed 100% satisfaction (n=15), 92% relief of symptoms (n=13) and 92% improvement of activities in both groups.ConclusionsFusion of the major thoracic curve using translational corrective technique (Isola) in patients with idiopathic scoliosis is an effective procedure that achieves high patient satisfaction while providing excellent correction of both the thoracic and lumbar curves. Unlike rotational corrective techniques (CD), clinical decompensation requiring further treatment did not occur in any patient treated with this method.

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