Intraoperative comparison of two instrumentation techniques for the correction of adolescent idiopathic scoliosis. Rod rotation and translation.

摘要

STUDY DESIGN: A prospective and controlled comparative study of two instrumentation techniques used for the correction of adolescent idiopathic scoliosis. OBJECTIVE: To measure the three-dimensional intraoperative correction obtained with a rotation maneuver as compared with that obtained with a translation maneuver of the first instrumentation rod inserted to determine the difference, if any, in the two techniques for achieving three-dimensional correction. SUMMARY OF BACKGROUND DATA: Adequate three-dimensional correction of scoliotic deformities has been reported with the Cotrel-Dubousset instrumentation using the rod-rotation maneuver. More recently, however, authors of studies with newer instrumentation systems have claimed that better correction can be obtained using a translation technique. So far, no report has clearly demonstrated the three-dimensional changes obtained with this more recent instrumentation technique. METHODS: The changes in position of thoracic and lumbar vertebrae exposed during surgery were documented using a three-dimensional magnetic digitizer in 70 adolescents with idiopathic scoliosis undergoing correction by a posterior approach. Vertebral positions were measured intraoperatively before and after the surgical maneuver in 39 patients with the Cotrel-Dubousset instrumentation (rod rotation) and in 31 patients with the Colorado instrumentation (translation). RESULTS: In both groups, adequate three-dimensional correction of the scoliotic deformities was documented, with significant changes in the frontal and sagittal planes and in the orientation of the plane of maximum deformity for thoracic and lumbar curves. On the other hand, no significant differences were documented between the two procedures except in the frontal plane where a tendency for greater correction was observed for thoracic curves with the translation technique. CONCLUSIONS: The two instrumentation techniques are equally able to achieve a comparable and effective three-dimensional correction of the scoliotic deformities. The use of either a rotation maneuver or a translation technique during surgery does not result in any significant measurable difference in three-dimensional correction.