TREATMENT OF ADOLESCENT IDIOPATHIC SCOLIOSIS USING TEXAS SCOTTISH RITE HOSPITAL INSTRUMENTATION

Study Design. To determine the effectiveness of Posterior TSRH instrum entation for the treatment of idiopathic scoliosis, 103 patients with a 2-year minimum followup were retrospectively studied. Methods. Patie nts who underwent operations between October 1988 and April 1991 were evaluated for curve correction, spinal balance, and complications. Age at surgery averaged 14.3 years. Follow-up averaged 2.5 years. Results . Thoracic curve correction averaged 65% in those with King Type III/I V curves and 54% in those with Type II curves. With follow-up, correct ion loss averaged approximately 13% for each group. Lumbar curve corre ction after instrumentation in Type I and II curves averaged 48% posto p but lost approximately 20% with follow-up. Trunk balance improved 77 % toward midline after surgery in those with Type III/IV curves. Impro vement in trunk balance was less impressive in patients with Type II c urves, particularly after selective thoracic fusions. Thoracic sagitta l contour improved 43% for hypokyphotic (<20-degrees) patients but, in the remainder, no significant radiographic change was evident. No neu rologic complications occurred. Delayed deep infections developed in t en patients (10%) between 11 and 45 months postoperative. Cultures eve ntually grew Propionibacterium acnes, staph epidermidis, or staph coag ulase negative in eight patients. Two patients had pseudarthroses. Con clusions. Frontal and sagittal thoracic curve correction can be satisf actorily obtained using TSRH instrumentation. Continued efforts are be ing made to improve lumbar hook patterns and technique to achieve and maintain better lumbar curve correction.