Veo CS - Hoi Nhi, Tieng Anh - BS NHAN Hanoi 2009

8/3/2019 Veo CS - Hoi Nhi, Tieng Anh - BS NHAN Hanoi 2009

http://slidepdf.com/reader/full/veo-cs-hoi-nhi-tieng-anh-bs-nhan-hanoi-2009 1/31

CURVE PROGRESSION AFTER ANTERIORCURVE PROGRESSION AFTER ANTERIOR

SURGICAL CORRECTION OF SCOLIOSIS:SURGICAL CORRECTION OF SCOLIOSIS:TWO CASES REPORTTWO CASES REPORT

Nguyen Thanh Nguyen Thanh Nhan Nhan * *

, Do Tran Khanh,, Do Tran Khanh,Vo Quang Vo Quang Dinh Dinh Nam, Huynh Nam, Huynh Manh Manh Nhi Nhi , Vu Viet , Vu Viet Chinh Chinh

PaediatricPaediatric Orthopedic DepartmentOrthopedic Department ––Hospital forHospital for TraumatologyTraumatology andand OrthopaedicsOrthopaedics

Ho ChiHo Chi MinhMinh CityCity –– VietnamVietnam

* MD,* MD, PaediatricPaediatric OrthopaedicOrthopaedic Department, Medical UniversityDepartment, Medical University



Peter O. Newton, Dennis R. WengerPeter O. Newton, Dennis R. Wenger

The indications for surgical correction of scoliosisThe indications for surgical correction of scoliosis::

-- Curve magnitudeCurve magnitude

-- Clinical deformityClinical deformity

-- Risk for progressionRisk for progression

-- Skeletal maturity, and curve pattern.Skeletal maturity, and curve pattern.

-- Thoracic curves of Cobb angle > 40 to 50Thoracic curves of Cobb angle > 40 to 50degrees in skeletally immature patientsdegrees in skeletally immature patientswhereas surgical correction is reserved forwhereas surgical correction is reserved forcurves of 50 degrees or more in mature patientscurves of 50 degrees or more in mature patients(lower risk of progression).(lower risk of progression).

-- Trunk deformity (rotation) and trunk balance areTrunk deformity (rotation) and trunk balance areimportant factors in deciding when to adviseimportant factors in deciding when to advise

surgical correction.surgical correction.

BACKGROUNDBACKGROUND



Peter O. Newton, Dennis R. WengerPeter O. Newton, Dennis R. Wenger

Anterior instrumentation and fusionAnterior instrumentation and fusion generallygenerally

include those with a single structural deformityinclude those with a single structural deformity

(thoracic,(thoracic, thoracolumbarthoracolumbar or lumbar curves,or lumbar curves,

Lenke 1A B C, 5 C).Lenke 1A B C, 5 C).




Lee S. Segal and Kelly L. Vanderhave

Anterior instrumentation is indicated for primarythoracic curves and thoracolumbar curves, with

the goal to save two or more levels compared

with that predicted for posterior

Fusion levels tend to extend from the proximal to

the distal end vertebrae measured in the Cobb

angle.




The potential advantages

Avoiding disruption of the posterior extensormusculature

Decreased risk of junctional problems

Superior long-term correction of thecompensatory noninstrumented curves with lesspostoperative coronal decompensation

Improved ability to derotate the spine in thetransverse plane

Better correction of thoracic hypokyphosis




The contraindications for anterior approach

- Significant preoperative kyphosis (>400),

- Curves greater than 800

- Impaired respiratory function (vital capacity < 50%)- And double or triple structural curves.




Historical problems with anterior instrumentation

- Rod breakage- Pull-out of the proximal screw

- Pseudoarthrosis

- Kyphosis.

These problems have been addressed with theuse of larger rods, structural grafts and spacers to

provide anterior column reconstruction, andmaintaining lordosis for thoracolumbar curves.




PURPOSEPURPOSE

To reviewTo review the indications for anterior surgicalthe indications for anterior surgical

correction of scoliosis.correction of scoliosis.

To evaluate used constructs.To evaluate used constructs.

To analyze the causes of progression ofTo analyze the causes of progression of

scoliosis.scoliosis.



MATERIALS AND METHODSMATERIALS AND METHODS

Retrospective studyRetrospective study

10/200310/2003 -- 3/20093/2009

151 patients: 57 male, 94 female151 patients: 57 male, 94 female

Female.

62.25%

Male.

37.75%



CAUSES OF SCOLIOSISCAUSES OF SCOLIOSIS

78 cases idiopathic scoliosis78 cases idiopathic scoliosis

53 cases congenital scoliosis53 cases congenital scoliosis 20 cases miscellaneous scoliosis20 cases miscellaneous scoliosis

51.65%

35.09%

13.24%

idiopathic

scoliosis

congenital

scoliosis

miscellious

scoliosis



SURGERY OF IDOPATHIC SCOLIOSISSURGERY OF IDOPATHIC SCOLIOSIS

1. POSTERIOR INSTRUMENTATION (69 cases)1. POSTERIOR INSTRUMENTATION (69 cases)

5 cases Harrington rods without fusion5 cases Harrington rods without fusion

4 cases Harrington rods with4 cases Harrington rods with sublaminarsublaminar wireswires

1 case hooks only1 case hooks only

20 cases hybrid constructs with segmental translation20 cases hybrid constructs with segmental translation – – pedicle screws and hooks ( 4 cases used 3 rods )pedicle screws and hooks ( 4 cases used 3 rods )

39 cases all pedicle screws39 cases all pedicle screws

22.. ANTERIOR SURGERY TECHNIQUES (9 cases)ANTERIOR SURGERY TECHNIQUES (9 cases)

9 cases with an anterior single9 cases with an anterior single--rod construct / 2rod construct / 2

cases revision due to progressive scoliosiscases revision due to progressive scoliosis



METHODSMETHODS

2/9 cases of anterior surgical correction of2/9 cases of anterior surgical correction of

scoliosis.scoliosis. ThoracoThoraco – – lumbar approach, discslumbar approach, discs discectomydiscectomy,,

vertebral screw with one single rod Moss Miami.vertebral screw with one single rod Moss Miami.

The results of correction are evaluated by CobbThe results of correction are evaluated by Cobbangle.angle.

PostPost--Op, wearing brace in 3Op, wearing brace in 3 – – 6 months.6 months.

Progressive scoliosis > 50Progressive scoliosis > 50

00

: posterior CD: posterior CDinstrumentation.instrumentation.



RESULTSRESULTS

Time follow up (12, 30 months)Time follow up (12, 30 months)

First correction results: Percentage correctedFirst correction results: Percentage corrected(63%, 76%).(63%, 76%).

Curve progressed (Cobb angle: 26Curve progressed (Cobb angle: 2600 565600,,

202000 525200))

Posterior CD instrumentation. PercentagePosterior CD instrumentation. Percentage

corrected (82%, 35%), trunk balance, nocorrected (82%, 35%), trunk balance, no

complications.complications.



Case 1:Case 1: Pt Nguyeãn Vuõ C 1993, Male, 14 YO.Pt Nguyeãn Vuõ C 1993, Male, 14 YO.

Cobb angle T10Cobb angle T10--L4: 70L4: 7000, Bending: 58, Bending: 5800

King 1King 1 -- LenkeLenke 5CN5CN

PreOp: Cobb angle T10 – L4: 700



PostOp: Cobb angle T10 – L4: 260 (percentage corrected: 63%)



1 year later, curve progressed, Cobb angel T10 – L4: 560



X ray PostOp:Cobb angle T10 – L4: 100

(percentage corrected 82%)



g







Case 2: Pt Vuõ Thaønh N, 1991, Male, 15 YO.

Cobb angle T9-L2: 840, Bending: 420

King 2 – Lenke 4BN

PreOp: Cobb angle T9 – L2: 840.



PostOp: Cobb angle T9 – L2: 200 (percentage corrected: 76%)



30 ms later, curve progressed, Cobb angle T8 – L2: 520



PostOp:

Cobb angle T8 – L2: 340

(percentage corrected 35%)



DISCUSSION

1. Surgery indication:

Case 1 (King 1, Lenke 5CN), anterior instrumentationindication is exact.

Case 2 (King 2, Lenke 4BN), anterior instrumentation

indication is wrong because of triple structural curve,

Cobb angle > 800 (840).



DISCUSSION

2. Anterior constructs gave good correction results

(63%, 76%) but both are not enough long because of

not reaching the proximal end and distal endvertebrae of Cobb angle.

We wish to do longer but the approach not enough

long Choosing the approach in anterior surgery

must be exact, long enough to gain effective

construct . Case 1 need to put 2 levels higher.Anterior instrumentation should only indicated for type

of short single structural curve, thoraco-lumbar or low

thoracic. .



DISCUSSION

3. Patient must wear brace enough time to have good

fusion. Need to closely follow up to detect progressive

curve.4. Adolescent patient (14, 15 YO, Risser V), still have

potential progressive scoliosis. Why?5. Have the problems in posterior instrumentation in

patient with anterior instrumentation?

Put pedicle screws.Have any interaction between different kinds of metal?



CONCLUSION

Anterior spinal instrumentation gave good correction,

but need to indicate exactly.

Instruments need enough strong and long (from the

proximal end to distal end vertebrae of the Cobbangle).

Need to programe follow up the curve. Posterior

correction instrumentation may be a good option.







Documents

Veo CS - Hoi Nhi, Tieng Anh - BS NHAN Hanoi 2009