Treatment of adolescent idiopathic scoliosis using Texas Scottish Rite Hospital instrumentation

Study Design, To determine the effectiveness of posterior TSRH instrumentat ion for the treatment of idiopathic scoliosis, 103 patients with a 2-year m inimum followup were retrospectively studied. Methods, Patients who underwent operations between October 1988 and April 1 991 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 /IV curves and 54% in those with Type ii curves. With follow-up, correction loss averaged approximately 13% for each group. Lumbar curve correction af ter instrumentation in Type I and Il curves averaged 48% postop but lost ap proximately 20% with follow-up. Trunk balance improved 77% toward midline a fter surgery in those with Type III/IV curves. Improvement in trunk balance was less impressive in patients with Type II curves, particularly after se lective thoracic fusions. Thoracic sagittal contour improved 43% for hypoky photic (<20 degrees) patients but, in the remainder, no significant radiogr aphic change was evident. No neurologic complications occurred. Delayed dee p infections developed in ten patients (10%) between 11 and 45 months posto perative. Cultures eventually grew Propionibacterium acnes, staph epidermid is, or staph coagulase negative in eight patients. Two patients had pseudar throses. Conclusions, Frontal and sagittal thoracic curve correction can be satisfac torily obtained using TSRH instrumentation. Continued efforts are being mad e to improve lumbar hook patterns and technique to achieve and maintain bet ter lumbar curve correction.