Scoliosis and Devices Instrumentation



  • Spinal fusion surgery recommended when curve magnitude > 40-45° for adolescent idiopathic scoliosis

  • Adult scoliosis presents with lumbar back ± leg pain, L3-L4 rotatory subluxation, L4-L5 tilt, and L5-S1 disc degeneration on radiographs


  • Radiographs

    • Main thoracic, thoracolumbar, and lumbar curves should be assessed for structural characteristics

    • 36′ standing anteroposterior & lateral radiographs & supine side-bending radiographs

    • In adult scoliosis, assess for degenerated changes and rotatory ± lateral listhesis

  • CT

    • Assess integrity of hardware

    • Look for osseous bridging at levels of interbody fusion and lucency along screw tracks

  • MR

    • Preoperative planning to evaluate for central &/or foraminal stenosis and disc degeneration

Clinical Issues

  • Adult bones tend to be weaker or osteoporotic, making instrumentation and fusion more difficult

  • Degenerative disc changes, spinal stenosis, and facet arthropathy can be exacerbated and in turn exacerbate scoliosis, leading to more rigid spines

  • Goals: Prevent progression, restore acceptability of clinical deformity, reduce curvature, prevent neurologic deficit

    • Resolve pain ± make it more controllable with medications

    • Fuse spine in as normal anatomical position as possible

Anteroposterior radiograph shows sigmoid scoliosis of the thoracic and lumbar spines . Fusion is extended to L5 if there is fixed tilt or subluxation at L4-L5, or to the sacrum if L5-S1 central or foraminal decompression is needed.

Anteroposterior radiograph depicts posterior fusion from the thoracolumbar junction to the sacrum . Extension of the fusion to the sacrum increases the incidence of pseudarthrosis and reoperation.

AP and lateral radiographs show fusion from the thoracic spine to the L5 level . Fusion is not terminated next to a severely degenerated segment. Proximal extension of the fusion should not stop distal to a proximal thoracic curve. Cross-links improve torsional stiffness.

Lateral radiograph shows posterior fusion and L3 pedicle subtraction osteotomy to restore lumbar lordosis. Lumbar scoliosis results in loss of lumbar lordosis with positive sagittal balance.


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