Sequential correction technique in degenerative scoliosis with type C coronal imbalance: a comparison with traditional 2-rod technique

Benlong Shi MD1, Dun Liu MD1, Zezhang Zhu MD1, Yu Wang MD1, Yang Li MD1, Zhen Liu MD1, Xu Sun MD1, and Yong Qiu MD1
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  • 1 Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China
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OBJECTIVE

The aim of this study was to compare the radiographic and clinical outcomes in patients with degenerative scoliosis (DS) with type C coronal imbalance who underwent either a sequential correction technique or a traditional 2-rod technique with a minimum of 2 years of follow-up.

METHODS

DS patients with type C coronal imbalance undergoing posterior correction surgery from February 2014 to January 2018 were divided into groups by technique: the sequential correction technique (SC group) and the traditional 2-rod technique (TT group). Radiographic parameters, including Cobb angle, coronal balance distance (CBD), global kyphosis (GK), thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT), and sacral slope, were assessed pre- and postoperatively. The SF-36 questionnaire was used to assess quality of life.

RESULTS

A total of 34 patients were included. Significant postoperative improvement in the Cobb angle of the main curve, CBD, GK, TK, LL, SVA, and PT was found in both groups (p < 0.05). Postoperatively, the coronal balance was type A in 13 patients (92.9%) in the SC group and in 16 patients (80.0%) in the TT group (p = 0.298). In the TT group, 1 patient had deteriorative coronal imbalance immediately postoperatively, and coronal imbalance deteriorated from type A to type C in 2 patients during follow-up. The scores of Physical Functioning, Role-Physical, Bodily Pain, Vitality, Social Functioning, Role-Emotional, and Mental Health were statistically improved postoperatively (p < 0.05) in both groups. Type C coronal imbalance at the last follow-up was associated with a relatively worse quality of life. There were no implant failures during follow-up in the SC group, whereas rod fracture was observed in 3 patients in the TT group.

CONCLUSIONS

Compared with the traditional 2-rod technique, the sequential correction technique can simplify rod installation procedure, enhance internal instrumentation, and reduce risk of implant failures. The sequential correction technique could be routinely recommended for DS patients with type C coronal imbalance.

ABBREVIATIONS

CBD = coronal balance distance; C7PL = C7 plumb line; DS = degenerative scoliosis; GK = global kyphosis; LL = lumbar lordosis; PI = pelvic incidence; PSO = pedicle subtraction osteotomy; PT = pelvic tilt; SC group = sequential correction technique group; SPO = Smith-Petersen osteotomy; SVA = sagittal vertical axis; TK = thoracic kyphosis; TLIF = transforaminal lumbar interbody fusion; TT group = traditional 2-rod technique group.

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  • 1

    Ploumis A, Simpson AK, Cha TD, Herzog JP, Wood KB. Coronal spinal balance in adult spine deformity patients with long spinal fusions: a minimum 2- to 5-year follow-up study. J Spinal Disord Tech. 2015;28(9):341347.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Bao H, Yan P, Qiu Y, Liu Z, Zhu F. Coronal imbalance in degenerative lumbar scoliosis: Prevalence and influence on surgical decision-making for spinal osteotomy. Bone Joint J. 2016;98-B(9):12271233.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Cho W, Mason JR, Smith JS, Shimer AL, Wilson AS, Shaffrey CI, et al. Failure of lumbopelvic fixation after long construct fusions in patients with adult spinal deformity: clinical and radiographic risk factors: clinical article. J Neurosurg Spine. 2013;19(4):445453.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Cho KJ, Suk SI, Park SR, Kim JH, Kang SB, Kim HS, Oh SJ. Risk factors of sagittal decompensation after long posterior instrumentation and fusion for degenerative lumbar scoliosis. Spine (Phila Pa 1976).2010;35(17):15951601.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5

    Bao H, Liu Z, Zhang Y, Sun X, Jiang J, Qian B, et al. Sequential correction technique to avoid postoperative global coronal decompensation in rigid adult spinal deformity: a technical note and preliminary results. Eur Spine J. 2019;28(9):21792186.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Kelly DM, McCarthy RE, McCullough FL, Kelly HR. Long-term outcomes of anterior spinal fusion with instrumentation for thoracolumbar and lumbar curves in adolescent idiopathic scoliosis. Spine (Phila Pa 1976).2010;35(2):194198.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7

    Moal B, Schwab F, Ames CP, Smith JS, Ryan D, Mummaneni PV, et al. Radiographic outcomes of adult spinal deformity correction: a critical analysis of variability and failures across deformity patterns. Spine Deform. 2014;2(3):219225.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Zhu ZZ, Chen X, Qiu Y, Chen ZH, Li S, Xu L, Sun X. Adding satellite rods to standard two-rod construct with the use of duet screws: an effective technique to improve surgical outcomes and preventing proximal junctional kyphosis in posterior-only correction of Scheuermann kyphosis. Spine (Phila Pa 1976).2018;43(13):E758E765.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9

    Obeid I, Berjano P, Lamartina C, Chopin D, Boissière L, Bourghli A. Classification of coronal imbalance in adult scoliosis and spine deformity: a treatment-oriented guideline. Eur Spine J. 2019;28(1):94113.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Ramieri A, Miscusi M, Domenicucci M, Raco A, Costanzo G. Surgical management of coronal and sagittal imbalance of the spine without PSO: a multicentric cohort study on compensated adult degenerative deformities. Eur Spine J. 2017;26(suppl 4):442449.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Wang N, Wang D, Wang F, Tan B, Yuan Z. Evaluation of degenerative lumbar scoliosis after short segment decompression and fusion. Medicine (Baltimore). 2015;94(47):e1824.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12

    Sun Y, Shen Y, Ding W, Qie S, Zhang W, Yang D, Wang L. Comparison in clinical outcome of two surgical treatments in degenerative scoliosis. Cell Biochem Biophys. 2014;70(1):189193.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Koller H, Pfanz C, Meier O, Hitzl W, Mayer M, Bullmann V, Schulte TL. Factors influencing radiographic and clinical outcomes in adult scoliosis surgery: a study of 448 European patients. Eur Spine J. 2016;25(2):532548.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Pitter FT, Lindberg-Larsen M, Pedersen AB, Dahl B, Gehrchen M. Revision risk after primary adult spinal deformity surgery: a nationwide study with two-year follow-up. Spine Deform. 2019;7(4):619626.e2.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Luca A, Ottardi C, Sasso M, Prosdocimo L, La Barbera L, Brayda-Bruno M, et al. Instrumentation failure following pedicle subtraction osteotomy: the role of rod material, diameter, and multi-rod constructs. Eur Spine J. 2017;26(3):764770.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Shen FH, Harper M, Foster WC, Marks I, Arlet V. A novel "four-rod technique" for lumbo-pelvic reconstruction: theory and technical considerations. Spine (Phila Pa 1976).2006;31(12):13951401.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17

    Kelly BP, Shen FH, Schwab JS, Arlet V, Diangelo DJ. Biomechanical testing of a novel four-rod technique for lumbo-pelvic reconstruction. Spine (Phila Pa 1976).2008;33(13):E400E406.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18

    Glassman SD, Berven S, Bridwell K, Horton W, Dimar JR. Correlation of radiographic parameters and clinical symptoms in adult scoliosis. Spine (Phila Pa 1976).2005;30(6):682688.

    • Crossref
    • Search Google Scholar
    • Export Citation

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