What is the surgical approach in the treatment of idiopathic scoliosis?

Updated: Dec 02, 2020
  • Author: Charles T Mehlman, DO, MPH; Chief Editor: Jeffrey A Goldstein, MD  more...
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Answer

Anterior approaches to this area of the spine were pioneered by Hodgson (Hong Kong), Dwyer (Australia), and Zielke (Germany). Current approaches represent further refinement of these original techniques, such as modern large rod-and-screw systems and the John Hall short anterior segment overcorrection technique. The value of such techniques lies in their ability to powerfully correct large thoracolumbar curvatures while minimizing fused segments within the lumbar spine.

There is little debate regarding the fixation of the rods used for anterior instrumentation. Large bone screws are almost always the anchor of choice. For posterior instrumentation procedures, the surgeon has more options. Multiple hooks are the most commonly used anchors. They offer simplicity, strength, and near complete visualization during insertion. Their main drawbacks relate to size mismatch between hooks and associated bony elements, as well as the absence of appropriate hook sites (such as might be the case in myelomeningocele, tumor cases, or revision surgeries).

Sublaminar wires offer the power of segmental fixation and firm bony purchase, but with the drawback of possible dural and/or spinal cord trauma. As a result, either very selective use of or no use at all of sublaminar wires is usually the case in the setting of idiopathic scoliosis. A reasonable compromise was achieved when Drummond introduced his spinous process wires (also known as Wisconsin wires). These devices still offer the power of segmental fixation with virtually none of the nerve injury risks of sublaminar wires.


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