Correction of Thoracic Hypokyphosis in Adolescent Scoliosis Using Patient-Specific Rod Templating
Abstract
:1. Introduction
2. Materials and Methods
3. Results
3.1. Coronal Plane Correction
3.2. Sagittal Plane Correction Parameters
3.3. Comparison of TK Achieved with Templating
4. Discussion
- Implant density and implant choice: Higher screw density on the concave side with thicker and cobalt chrome rods have been associated with restoration of kyphosis to greater than 20 degrees [31]. Reduction in the implant density, however, also means the load exerted on each anchor is increased. One simulation study showed that the pull-out force exerted on the screw in the apical vertebra increased 2.5-fold when screw density decreased from 2.0 to 1.0 [32].
- Surgical correction technique: Dual differential rod contouring has been shown to achieve the best vertebral rotation [11,18]. Thoracic kyphosis is best restored through the dual rod posteromedial correction technique [33,34]. Manoeuvres such as simple rod roll and direct vertebral de-rotation have been found to worsen hypokyphosis as they are inherently lordogenic in nature [35,36].
- Restoring TK to a value of 20–40° regardless of pre-operative TK value.
- Post-operative TK achieved was within 5.5° of the value predicted using templating.
- Excellent coronal plane correction in addition to the correction of TK.
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Total Patients | 61 (53F) |
---|---|
Lenke 1 | 29 |
Lenke 2 | 13 |
Lenke 3 | 7 |
Lenke 4 | 12 |
Lumbar Modifier | |
A | 31 |
B | 8 |
C | 22 |
Thoracic Modifier | |
− | 5 |
N | 43 |
+ | 13 |
Measurement | Pre-op Angle | Post-op Angle | Change in Angle | % Change | p Value |
---|---|---|---|---|---|
Proximal Thoracic | 30.5° ± 10.2 | 15.6° ± 7.1 | 14.9° ± 7.9 | 48.1% ± 22.5 | <0.001 |
Main Thoracic | 68.5° ± 13.4 | 17.4° ± 9.0 | 51.2° ± 10.2 | 75.4% ± 11.3 | <0.001 |
Thoraco–Lumbar | 43.4° ± 14.2 | 15.5° ± (9.1) | 28.6° ± 12.1 | 67.4% ± 28.0 | <0.001 |
Clavicle Angle | |
---|---|
Pre-op | −2.5°± 3.2° |
Post-op | 3.0° ± 2.7° |
p Value | <0.001 |
T1 Tilt | |
Pre-op | −2.4(+/−8.81) |
Post-op | 5.42(+/−5.2) |
p Value | <0.001 |
Pre-op | Post-op | Mean Difference | p Value | |
---|---|---|---|---|
Thoracic Kyphosis (all) | 34.6° ± 14.6° | 33.1° ± 9.0 | –1.4 ± 12.7 | |
PI-LL | −10.7 | −6.5 | −4.3 | 0.0074 |
PT | 7.8° ± 8.2° | 10.8° ± 9.3° | 2.6 | 0.0012 |
SVA | –13.5 ± 36.7 | –6.9 ± 37.1 | 6.7 | 0.3087 |
TPA | 3.0 ± 8.2 | 6.2 ± 9.6 | 2.8 | 0.0061 |
N | Pre-op | Post-op | Mean Difference (∆TK) | p Value | |
---|---|---|---|---|---|
Thoracic Kyphosis (all) | 61 | 34.6° ± 14.6° | 33.1° ± 9.0 | –1.4° | |
TK Hypokyhphosis group | 7 | 8.4° ± 9.5° | 22.4°± 3.7° | 14.0° | 0.0096 |
TK Normo-kyhphosis group | 33 | 30.5° ± 5.7° | 32.1° ± 6.8° | 1.62° | 0.2731 |
TK Hyperkyhphosis group | 21 | 49.2° ± 7.7° | 38.2° ± 9.5° | −11.0° | 0.001 |
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Marya, S.; Elmalky, M.; Schroeder, A.; Tambe, A. Correction of Thoracic Hypokyphosis in Adolescent Scoliosis Using Patient-Specific Rod Templating. Healthcare 2023, 11, 980. https://doi.org/10.3390/healthcare11070980
Marya S, Elmalky M, Schroeder A, Tambe A. Correction of Thoracic Hypokyphosis in Adolescent Scoliosis Using Patient-Specific Rod Templating. Healthcare. 2023; 11(7):980. https://doi.org/10.3390/healthcare11070980
Chicago/Turabian StyleMarya, Shivan, Mahmoud Elmalky, Alex Schroeder, and Anant Tambe. 2023. "Correction of Thoracic Hypokyphosis in Adolescent Scoliosis Using Patient-Specific Rod Templating" Healthcare 11, no. 7: 980. https://doi.org/10.3390/healthcare11070980
APA StyleMarya, S., Elmalky, M., Schroeder, A., & Tambe, A. (2023). Correction of Thoracic Hypokyphosis in Adolescent Scoliosis Using Patient-Specific Rod Templating. Healthcare, 11(7), 980. https://doi.org/10.3390/healthcare11070980