Scoliosis Correction Maintenance in Skeletally Immature Patients With Idiopathic Scoliosis
- 1 January 2000
- journal article
- Published by Wolters Kluwer Health in Spine
- Vol. 25 (1) , 61-8
- https://doi.org/10.1097/00007632-200001010-00012
Abstract
A retrospective evaluation of the occurrence of the crankshaft phenomenon in skeletally immature patients with idiopathic scoliosis. To determine what factors, if any, contribute to a decreased occurrence of crankshaft phenomenon in patients treated with posterior surgery only. Reports have described the progression of scoliotic deformity, termed the crankshaft phenomenon, in a region of solid posterior arthrodesis in skeletally immature patients. This has led some authors to advocate the use of concomitant anterior discectomy and fusion to prevent crankshaft. From 1989 through 1994, 18 Risser 0 patients with thoracic or thoracolumbar idiopathic scoliosis underwent Isola (De Puy-Acromed, Raynham, MA) posterior instrumentation and fusion. They were assessed for evidence of the crankshaft phenomenon, identified by coronal plane deformity progression of 10 degrees or more, or a rib vertebra angle difference of 10 degrees or more. The average age of the patients was 12.5 years (range, 10.5-15.5 years), and the average follow-up period was 39 months (range, 24-68 months). Eleven patients (10 girls and 1 boy) had closed triradiate cartilage at the time of surgery. Their average Cobb angle was 62 degrees before surgery, 21 degrees after surgery, and 22 degrees at follow-up assessment. No patients in this group met the criteria for crankshaft. Seven patients (6 girls and 1 boy) had open triradiate cartilage at the time of surgery. Their average Cobb angle was 62 degrees before surgery, 18 degrees after surgery, and 20 degrees at follow-up evaluation. No patient had a 10 degrees or more increase in rib vertebra angle difference. One patient had more than a 10 degrees increase in her Cobb angle (11 degrees) from postoperative to latest follow-up assessment. Her instrumentation construct, performed in 1989, used sublaminar wires as the caudal anchors. Hooks and pedicle screws are now used. Two of the seven patients with open triradiate cartilage underwent surgery during or before their peak height velocity and displayed no evidence of crankshaft. No deaths, neurologic complications, or infections occurred in either group. These findings suggest that scoliotic deformity progression can be prevented in skeletally immature patients with idiopathic scoliosis as young as 10 years of age with the use of stiff segmental posterior instrumentation, without the necessity of concomitant anterior arthrodesis.Keywords
This publication has 19 references indexed in Scilit:
- The Selection of Fusion Levels Using Torsional Correction Techniques in the Surgical Treatment of Idiopathic ScoliosisSpine, 1999
- A Concept of Idiopathic Scoliosis Deformities as Imperfect Torsion(s)Published by Wolters Kluwer Health ,1999
- Posterior Arthrodesis in the Skeletally Immature PatientSpine, 1997
- Overpowering the Crankshaft MechanismSpine, 1996
- Preventing the Crankshaft Phenomenon by Combining Anterior Fusion With Posterior InstrumentationSpine, 1995
- Prevention of the crankshaft phenomenon with anterior spinal epiphysiodesis in surgical treatment of severe scoliosis of the younger patientEuropean Spine Journal, 1994
- The Crankshaft PhenomenonJournal of Pediatric Orthopaedics, 1989
- Static and dynamic loading patterns in knee joints with deformities.Journal of Bone and Joint Surgery, 1983
- Bone Growth after Spine FusionJournal of Bone and Joint Surgery, 1960
- Spine Fusion in Young ChildrenJournal of Bone and Joint Surgery, 1957