Since the advent of single, stiff rod anterior instrumentation, and now dual rod anterior instrumentation, most thoracolumbar-lumbar scoliosis is treated with an anterior approach. We have previously reported a retrospective comparison of patients with single torsion thoracolumbar-lumbar scoliosis treated with either anterior or posterior instrumented fusion. The purpose of this study is to examine the patient-based outcomes in this cohort of patients at an average of 5 years (anterior instrumentation) and 9 years (posterior instrumentation). ⋯ At an average of 9 years of follow-up, patients treated with posterior transpedicular instrumentation have equivalent patient-based outcomes to patients treated with anterior single solid rod instrumentation at an average of 5 years of follow-up.
Section of Orthopedic Surgery and the Department of Preventative Medicine, University of Kansas Medical Center, Kansas City 66160-7387, USA. dburton@kumc.edu
Spine. 2002 Nov 1;27(21):2363-7.
IntroductionSince the advent of single, stiff rod anterior instrumentation, and now dual rod anterior instrumentation, most thoracolumbar-lumbar scoliosis is treated with an anterior approach. We have previously reported a retrospective comparison of patients with single torsion thoracolumbar-lumbar scoliosis treated with either anterior or posterior instrumented fusion. The purpose of this study is to examine the patient-based outcomes in this cohort of patients at an average of 5 years (anterior instrumentation) and 9 years (posterior instrumentation).Materials And MethodsInclusion criteria were as follows: 1) single torsion thoracolumbar or lumbar curve of ResultsPosterior: The average age was 14.8 years (range 12-17.8 years). Curve correction at average 6.5 years (range 4.0-10.9 years) was 75%. The average lower instrumented vertebra was L3.1. There were no complications. Twelve of 14 patients completed SRS 22 at an average of 9.2 years (range 6.2-10.9 years). Domain scores for Pain, Self-Image, Function, Mental Health, Satisfaction, and Total were 3.8, 4.1, 4.0, 3.8, 4.5, and 4.1, respectively. Anterior: The mean age was 14.5 years (range 12.5-16.5 years). Curve correction at average 4.8 years (range 2.3-7.6 years) was 63% (instrumented segment 89%). The average lower instrumented vertebra was L2.6. Complications included one intercostal neuritis that resolved with suture removal, one broken inferior screw that healed with some loss of correction, and one pseudarthrosis treated successfully with posterior fusion. Fourteen of 14 patients completed SRS 22 at an average of 5.3 years (range 2.0-7.6 years). Domain scores for Pain, Self-Image, Function, Mental Health, Satisfaction, and Total were 4.1, 4.3, 4.4, 4.0, 4.5, and 4.3, respectively. There were no statistically significant differences in any of the domains or the Total score, although there was a trend toward improved function in the patients treated anteriorly. The follow-up was statistically longer in the posterior group.ConclusionAt an average of 9 years of follow-up, patients treated with posterior transpedicular instrumentation have equivalent patient-based outcomes to patients treated with anterior single solid rod instrumentation at an average of 5 years of follow-up.