The posterior approach for lumbar and thoracolumbar adolescent idiopathic scoliosis: Posterior shortening and pedicle screws

Study Design. Prospective clinical case series. Background Data. Lumbar and thoracolumbar adolescent idiopathic scoliosis has traditionally been treated with an anterior approach and instrumentation. This anterior method often has had problems with kyphosis, pseudarthrosis, and loss of correction. The senior author has had good results treating these same lumbar and thoracolumbar curves posteriorly with wide posterior release and segmental instrumentation. In this series of his evolving technique, he adds pedicle screws as the sole anchor in the thoracolumbar/ lumbar curves. Objectives. To prospectively evaluate outcomes, coronal and sagittal radiographic results, balance parameters, complications, and reoperations in a group of consecutive patients with lumbar and thoracolumbar adolescent idiopathic scoliosis. These patients were surgically treated with wide posterior release and segmental posterior screw instrumentation with 2- year minimum follow-up ( range 26 - 47 months). Methods. Sixty- two consecutive patients with thoracolumbar and lumbar adolescent idiopathic scoliosis were treated with a wide posterior release and segmental pedicle screw instrumentation limited to the curve defined by the Cobb measurement. The patients were evaluated clinically and radiographically at intervals up to 36 months. There was 2- year minimum follow- up. Results. One patient was lost to follow- up. Of the remaining 61 patients, there were 51 Lenke 5 Type curves, 7 Lenke Type 3C curves, and 3 Lenke Type 6 curves. Only the curve defined by the Cobb measurement was fused. A total of 613 pedicle screws were placed safely. Average coronal correction of the thoracolumbar/ lumbar curves was from 52degrees to 10degrees ( 80%). In the sagittal plane, lumbar lordosis was normalized from 41degrees with a wide range ( 20degrees - 70degrees) to 42degrees with a normal range ( 34degrees - 47degrees). There were no pseudoarthroses, no reoperations, no infections, no problems with screw placement, and excellent maintenance of correction at last follow- up. The lowest instrumented vertebrae had 81% correction of coronal angulation, center sacral line to lowest instrumented vertebrae was improved from 2.4 cm to 0.7 cm, and apex to center sacral line was improved from 5.2 cm to 1.5 cm. The C7 plumb line to center sacral line was also improved from 2.5 cm to 0.6 cm, illustrating the centering of the trunk. Conclusions. Wide posterior release and segmental pedicle screw instrumentation has excellent radiographic and clinical results with minimal complications. There were no pseudoarthroses and no reoperations.