Effectiveness and safety of posterior titanium instrumentation in children with adolescent idiopathic scoliosis: a prospective study
Murat Oto, Suken A. Shah, Mohammed Ali Hassan Mohammed, Kenny J Rogers, Petya Yorgova, Laurens Holmes
Department of Orthopedics, Nemours AI DuPont Hospital for Children, Wilmington, DE, USA
Keywords: Adolescent; fusion; posterior instrumentation; scoliosis; titanium.
Objectives: This study aims to determine the effectiveness and the relative safety of posterior spinal fusion with titanium instrumentation in children with adolescent idiopathic scoliosis (AIS).
Patients and methods: A prospective cohort (case-only) study was conducted to determine this effectiveness and safety. There were 24 patients (21 girls, 3 boys; mean age 14.1±1.8 years; range 11 to 17 years) who underwent surgery between January 2002 and December 2003 in our clinic, with a minimum of two years follow-up. Upper thoracic, thoracic, and thoracolumbar coronal curves as well as kyphosis from T5-T12 were measured as main outcome variables and repeated measure ANOVA was used to assess the data.
Results: The main thoracic curve (coronal plane) correction achieved at the first erect period (the first 4 weeks postoperative) (mean 12.21±9.78 degrees), this correction was maintained at 24 months follow-up (mean 15.71±7.15 degrees) and both were significantly lower than the preoperative values (mean 57.0±12.75 degrees), (p<0.001). Sagittal plane (kyphosis angle between T5-T12) curve was not worsened by posterior titanium instrumentation and it was 19.50±10.53 degrees preoperatively, 16.45±6.68 degrees at the first erect period and 17.73±8.40 degrees at the 24 months follow-up (p=0.74). There were no evidence of pseudoarthrosis, no loss of correction and no infections.
Conclusion: Posterior titanium instrumentation in the treatment of AIS is effective due to its ability to achieve and maintain curve correction. Further, this instrumentation does not worsen hypokyphosis and is safe since there were no adverse events.