Comparison of Circular and Sagittal Reinforced Rod Options on Sagittal Balance Restoration in Adolescents Undergoing Pedicle Screw Instrumentation for Idiopathic Scoliosis

• Published in: World neurosurgery 2019-07, Vol.127, p.e1020-e1025
• Main Authors: Lastikka, Markus, Oksanen, Hanna, Helenius, Linda, Pajulo, Olli, Helenius, Ilkka
• Format: Article
• Language: English
• Subjects: Adolescent; Adolescent idiopathic scoliosis; Cobalt-chromium rod; Female; Follow-Up Studies; Humans; Male; Pedicle screw instrumentation; Pedicle Screws - standards; Posterior spinal fusion; Postural Balance - physiology; Prospective Studies; Scoliosis - diagnostic imaging; Scoliosis - surgery; Spinal Fusion - instrumentation; Spinal Fusion - standards; Thoracic kyphosis; Thoracic Vertebrae - diagnostic imaging; Thoracic Vertebrae - surgery
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2019.04.028

Pedicle screw instrumentation is widely used for spinal deformity correction and fusion in adolescents for idiopathic scoliosis. The goal is to achieve and sustain good alignment in all 3 planes. We compared 2 different cobalt-chromium (CoCr) rod designs with different stiffnesses with regard to the restoration of coronal and sagittal balance in adolescents operated on for idiopathic scoliosis. A prospective comparative study was made of 90 consecutive adolescents, mean age (standard deviation) 15.6 years (2.1 years), with idiopathic scoliosis who underwent posterior spinal fusion by the use of bilateral segmental pedicle screw instrumentation (PSI) with 6.0 Co-Cr rods. Fifty-four adolescents (43 girls) were operated on by the use of circular rods and 36 (27 girls) by the use of sagittal reinforced rods, with a 2-year follow-up. Preoperative major coronal curves were similar and at 2 years: 11° (5.0) and 17° (7.2) with correction percentages of 78% (10) and 69% (12) in the circular and reinforced rod groups (P < 0.01). Thoracic kyphosis at 2 years measured 16° (7) and 21° (6) in the circular and reinforced rod groups (P < 0.01). The number of patients with hypokyphosis was lower in the reinforced rod group at 2 years (P = 0.02). In the reinforced rod group, there was a negative correlation between coronal correction and thoracic kyphosis (r = −0.52, P < 0.01). Both circular and sagittal reinforced 6.0-mm CoCr rods provide adequate coronal correction for adolescents with idiopathic scoliosis. The use of sagittal reinforced rods provided better thoracic kyphosis restoration and a lower risk for postoperative hypokyphosis.