Gatam Luthfi, Luthfi Andi Praja Wira Yudha, Gatam Asrafi Rizki, Djaja Yoshi Pratama
Department of Orthopaedic and Traumatology, Fatmawati General Hospital, Jakarta, Indonesia.
Resident of Orthopaedic Surgery, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
Int J Surg Case Rep. 2020;77:39-44. doi: 10.1016/j.ijscr.2020.10.072. Epub 2020 Oct 25.
Adolescent idiopathic scoliosis (AIS) can lead to severe deformity. However, early detection and treatment can prevent its progression. Surgical instrumentation for scoliosis treatment has evolved from Harrington instrumentation to pedicle screws. However, there are still some concerns about the efficacy and long-term effects of pedicle screw fixation, and the clinical and radiographic outcomes of surgical treatment for severe AIS (>90°) by posterior spinal fusion alone need to be established.
Eight patients with severe and rigid idiopathic scoliosis were recruited for this study. All surgeries were performed by one senior spine surgeon between 2015 and 2018. Free hand technique, intraoperative neurophysiologic monitoring (IONM), and intraoperative fluoroscopy to assess the screw position was performed.
Severe scoliosis results in a complex three-dimensional spinal deformity that often requires correction in multiple planes. Mean major coronal correction rate was 67% (45-80%). No major complications occurred during the perioperative period and after one year follow up.
Pedicle screws provide three-dimensional deformity correction. There were no complications other than the low-grade late implant-associated infections. Posterior spinal fusion with pedicle screw-only instrumentation obtains a good and stable correction for severe scoliosis.
青少年特发性脊柱侧凸（AIS）可导致严重畸形。然而，早期发现和治疗可预防其进展。脊柱侧凸治疗的手术器械已从哈灵顿器械发展到椎弓根螺钉。然而，对于椎弓根螺钉固定的疗效和长期影响仍存在一些担忧，仅通过后路脊柱融合术治疗严重AIS（>90°）的临床和影像学结果有待确定。
本研究招募了8例严重僵硬型特发性脊柱侧凸患者。所有手术均由一位资深脊柱外科医生在2015年至2018年期间完成。采用徒手技术、术中神经生理监测（IONM）以及术中透视来评估螺钉位置。
严重脊柱侧凸会导致复杂的三维脊柱畸形，通常需要在多个平面进行矫正。平均主冠状面矫正率为67%（45%-80%）。围手术期及术后一年随访期间未发生重大并发症。
椎弓根螺钉可提供三维畸形矫正。除了低度晚期植入物相关感染外，未出现其他并发症。仅采用椎弓根螺钉器械的后路脊柱融合术对严重脊柱侧凸可获得良好且稳定的矫正效果。
