Augmentation of third generation instrumentation with sublaminar titanium wiring in late onset idiopathic scoliosis: the surgical results and analysis of trunk balance.

In recent years, third generation instrumentation systems which achieve correction by maneuvers like derotation and translation, have been widely used in the treatment of idiopathic scoliosis. To increase correction, additional procedures that increase stability, such as screw application for every segment, have been used. In this study, as a new technique, the effects of combined translation and derotation maneuver with augmentation by using titanium double crimp Songer cable applied on apical region, on trunk balance, sagittal and frontal planes have been examined. 45 idiopathic scoliosis patients operated between 1996 and 2002 have been included in the study. Mean age was 14.5+/-1.7 years and female/male ratio was 30/15. Mean follow up time was 51.9+/-22.7 months. According to King Classification, 15 patients had Type II, 18 patients Type III and 12 patients had Type IV curves. One of the apical cables has been tensioned and translation has been performed. At the second step, derotation has been applied to the vertebra, which is firmly attached to the rod. Sagittal and frontal Cobb angles have been measured in preoperative, postoperative and recent radiographic examinations. Trunk balance has been examined both clinically and radiographically. Also, secondary curves have been measured in every examination for decompensation findings. In overall frontal plane measurements, postoperative correction was 79.9+/-13.5 %, loss of correction 2.9 degrees +/-3.2 degrees and final correction 74.3 % +/-14.3 %. In postoperative measurements, normal physiological contours have been achieved in 97.8 % of the patients for the thoracic region (30 degrees -50 degrees ) and 80.7 % of the patients for the lumbar region (40 degrees -60 degrees ). In secondary curves, 75.2+/-34.4 % postoperative correction has been observed. No decompensation findings have been observed in the last examination. In postoperative and last follow up examinations, balanced and totally balanced vertebral column has been achieved in every patient of the study group. Solid fusion mass has been observed in every patient. No early or late, local or systemic postoperative complications have been observed. Given these findings, we conclude that derotation-translation combined maneuver performed with 3rd generation instrumentation reinforced sublaminar wires is a good choice in the treatment of the late-onset idiopathic scoliosis.