Comparison of radiographic outcomes for the treatment of scoliotic curves greater than 100 degrees: Wires versus hooks versus screws

Kei Watanabe, Lawrence G. Lenke, Keith H. Bridwell, Yongjung J. Kim, Koota Watanabe, Young Woo Kim, Youngbae B. Kim, Marsha Hensley, Georgia Stobbs

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Abstract

STUDY DESIGN. A retrospective comparative study. OBJECTIVE. To compare the efficacy and safety of several different anchors in the apical levels of scoliotic curves ≥100° using radiographic outcomes and clinical complications. SUMMARY OF BACKGROUND DATA. To the best of our knowledge, no reports have compared various anchors at the apical level for correction of scoliosis curves ≥100°. METHODS. Sixty-eight scoliosis patients (44 neuromuscular, 21 idiopathic, and 3 congenital) with major curves ≥100° (mean, 112.7°; range, 100°-159°) who underwent segmental spinal instrumentation and fusion with different anchors in the apical level were analyzed. All patients had a minimum 2-year follow-up (mean, 4.0 years; range, 2.0-10.5) and were divided into Group W (sublaminar wires n = 26), Group H (hooks n = 18), Group A (anterior vertebral screws n = 7), and Group PS (pedicle screws n = 17) based on the type of apical anchor used. Radiographic parameters and complications were investigated. RESULTS. The 4 groups did not demonstrate any significant differences in gender, age at surgery, preoperative major Cobb angle, or curve flexibility (all P > 0.05). However, the PS group demonstrated a shorter follow-up period compared with the other 3 groups (P < 0.05). The PS group demonstrated the greatest correction rate, smallest loss of correction (P < 0.05), and greatest amount of correction of the apical vertebral translation (P < 0.0005) at ultimate follow-up. There were 4 cases (5.9%) of pseudarthrosis (3 in Group W, 1 in Group H; P > 0.05), 6 cases (8.8%) of implant failure (4 in Group W, 2 in Group H; P > 0.05). Despite one (1.5%) intraoperative neurologic complication (differences among groups, P > 0.05), there was no permanent neurologic deficit. CONCLUSION. All 4 constructs were able to achieve and maintain acceptable correction safely without permanent neurologic deficit and all demonstrated acceptable implant failure rate. Pedicle screw constructs in the apical levels demonstrated the best coronal correction, smallest loss of correction, and greatest amount of apical vertebral translation correction of the major Cobb angle compared with the other constructs without neurologic complications.

Original languageEnglish
Pages (from-to)1084-1092
Number of pages9
JournalSpine
Volume33
Issue number10
DOIs
Publication statusPublished - 2008 May

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Scoliosis
Neurologic Manifestations
Nervous System
Spinal Fusion
Intraoperative Complications
Retrospective Studies
Safety
Pedicle Screws

Keywords

  • 100 degrees
  • Apical anchors
  • Outcomes
  • Scoliosis

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Comparison of radiographic outcomes for the treatment of scoliotic curves greater than 100 degrees : Wires versus hooks versus screws. / Watanabe, Kei; Lenke, Lawrence G.; Bridwell, Keith H.; Kim, Yongjung J.; Watanabe, Koota; Kim, Young Woo; Kim, Youngbae B.; Hensley, Marsha; Stobbs, Georgia.

In: Spine, Vol. 33, No. 10, 05.2008, p. 1084-1092.

Research output: Contribution to journalArticle

Watanabe, K, Lenke, LG, Bridwell, KH, Kim, YJ, Watanabe, K, Kim, YW, Kim, YB, Hensley, M & Stobbs, G 2008, 'Comparison of radiographic outcomes for the treatment of scoliotic curves greater than 100 degrees: Wires versus hooks versus screws', Spine, vol. 33, no. 10, pp. 1084-1092. https://doi.org/10.1097/BRS.0b013e31816f5f3a
Watanabe, Kei ; Lenke, Lawrence G. ; Bridwell, Keith H. ; Kim, Yongjung J. ; Watanabe, Koota ; Kim, Young Woo ; Kim, Youngbae B. ; Hensley, Marsha ; Stobbs, Georgia. / Comparison of radiographic outcomes for the treatment of scoliotic curves greater than 100 degrees : Wires versus hooks versus screws. In: Spine. 2008 ; Vol. 33, No. 10. pp. 1084-1092.
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abstract = "STUDY DESIGN. A retrospective comparative study. OBJECTIVE. To compare the efficacy and safety of several different anchors in the apical levels of scoliotic curves ≥100° using radiographic outcomes and clinical complications. SUMMARY OF BACKGROUND DATA. To the best of our knowledge, no reports have compared various anchors at the apical level for correction of scoliosis curves ≥100°. METHODS. Sixty-eight scoliosis patients (44 neuromuscular, 21 idiopathic, and 3 congenital) with major curves ≥100° (mean, 112.7°; range, 100°-159°) who underwent segmental spinal instrumentation and fusion with different anchors in the apical level were analyzed. All patients had a minimum 2-year follow-up (mean, 4.0 years; range, 2.0-10.5) and were divided into Group W (sublaminar wires n = 26), Group H (hooks n = 18), Group A (anterior vertebral screws n = 7), and Group PS (pedicle screws n = 17) based on the type of apical anchor used. Radiographic parameters and complications were investigated. RESULTS. The 4 groups did not demonstrate any significant differences in gender, age at surgery, preoperative major Cobb angle, or curve flexibility (all P > 0.05). However, the PS group demonstrated a shorter follow-up period compared with the other 3 groups (P < 0.05). The PS group demonstrated the greatest correction rate, smallest loss of correction (P < 0.05), and greatest amount of correction of the apical vertebral translation (P < 0.0005) at ultimate follow-up. There were 4 cases (5.9{\%}) of pseudarthrosis (3 in Group W, 1 in Group H; P > 0.05), 6 cases (8.8{\%}) of implant failure (4 in Group W, 2 in Group H; P > 0.05). Despite one (1.5{\%}) intraoperative neurologic complication (differences among groups, P > 0.05), there was no permanent neurologic deficit. CONCLUSION. All 4 constructs were able to achieve and maintain acceptable correction safely without permanent neurologic deficit and all demonstrated acceptable implant failure rate. Pedicle screw constructs in the apical levels demonstrated the best coronal correction, smallest loss of correction, and greatest amount of apical vertebral translation correction of the major Cobb angle compared with the other constructs without neurologic complications.",
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T2 - Wires versus hooks versus screws

AU - Watanabe, Kei

AU - Lenke, Lawrence G.

AU - Bridwell, Keith H.

AU - Kim, Yongjung J.

AU - Watanabe, Koota

AU - Kim, Young Woo

AU - Kim, Youngbae B.

AU - Hensley, Marsha

AU - Stobbs, Georgia

PY - 2008/5

Y1 - 2008/5

N2 - STUDY DESIGN. A retrospective comparative study. OBJECTIVE. To compare the efficacy and safety of several different anchors in the apical levels of scoliotic curves ≥100° using radiographic outcomes and clinical complications. SUMMARY OF BACKGROUND DATA. To the best of our knowledge, no reports have compared various anchors at the apical level for correction of scoliosis curves ≥100°. METHODS. Sixty-eight scoliosis patients (44 neuromuscular, 21 idiopathic, and 3 congenital) with major curves ≥100° (mean, 112.7°; range, 100°-159°) who underwent segmental spinal instrumentation and fusion with different anchors in the apical level were analyzed. All patients had a minimum 2-year follow-up (mean, 4.0 years; range, 2.0-10.5) and were divided into Group W (sublaminar wires n = 26), Group H (hooks n = 18), Group A (anterior vertebral screws n = 7), and Group PS (pedicle screws n = 17) based on the type of apical anchor used. Radiographic parameters and complications were investigated. RESULTS. The 4 groups did not demonstrate any significant differences in gender, age at surgery, preoperative major Cobb angle, or curve flexibility (all P > 0.05). However, the PS group demonstrated a shorter follow-up period compared with the other 3 groups (P < 0.05). The PS group demonstrated the greatest correction rate, smallest loss of correction (P < 0.05), and greatest amount of correction of the apical vertebral translation (P < 0.0005) at ultimate follow-up. There were 4 cases (5.9%) of pseudarthrosis (3 in Group W, 1 in Group H; P > 0.05), 6 cases (8.8%) of implant failure (4 in Group W, 2 in Group H; P > 0.05). Despite one (1.5%) intraoperative neurologic complication (differences among groups, P > 0.05), there was no permanent neurologic deficit. CONCLUSION. All 4 constructs were able to achieve and maintain acceptable correction safely without permanent neurologic deficit and all demonstrated acceptable implant failure rate. Pedicle screw constructs in the apical levels demonstrated the best coronal correction, smallest loss of correction, and greatest amount of apical vertebral translation correction of the major Cobb angle compared with the other constructs without neurologic complications.

AB - STUDY DESIGN. A retrospective comparative study. OBJECTIVE. To compare the efficacy and safety of several different anchors in the apical levels of scoliotic curves ≥100° using radiographic outcomes and clinical complications. SUMMARY OF BACKGROUND DATA. To the best of our knowledge, no reports have compared various anchors at the apical level for correction of scoliosis curves ≥100°. METHODS. Sixty-eight scoliosis patients (44 neuromuscular, 21 idiopathic, and 3 congenital) with major curves ≥100° (mean, 112.7°; range, 100°-159°) who underwent segmental spinal instrumentation and fusion with different anchors in the apical level were analyzed. All patients had a minimum 2-year follow-up (mean, 4.0 years; range, 2.0-10.5) and were divided into Group W (sublaminar wires n = 26), Group H (hooks n = 18), Group A (anterior vertebral screws n = 7), and Group PS (pedicle screws n = 17) based on the type of apical anchor used. Radiographic parameters and complications were investigated. RESULTS. The 4 groups did not demonstrate any significant differences in gender, age at surgery, preoperative major Cobb angle, or curve flexibility (all P > 0.05). However, the PS group demonstrated a shorter follow-up period compared with the other 3 groups (P < 0.05). The PS group demonstrated the greatest correction rate, smallest loss of correction (P < 0.05), and greatest amount of correction of the apical vertebral translation (P < 0.0005) at ultimate follow-up. There were 4 cases (5.9%) of pseudarthrosis (3 in Group W, 1 in Group H; P > 0.05), 6 cases (8.8%) of implant failure (4 in Group W, 2 in Group H; P > 0.05). Despite one (1.5%) intraoperative neurologic complication (differences among groups, P > 0.05), there was no permanent neurologic deficit. CONCLUSION. All 4 constructs were able to achieve and maintain acceptable correction safely without permanent neurologic deficit and all demonstrated acceptable implant failure rate. Pedicle screw constructs in the apical levels demonstrated the best coronal correction, smallest loss of correction, and greatest amount of apical vertebral translation correction of the major Cobb angle compared with the other constructs without neurologic complications.

KW - 100 degrees

KW - Apical anchors

KW - Outcomes

KW - Scoliosis

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