The Effect Of Surgical Approaches On Postoperative Sagittal Profile Reconstruction Following Selective Thoracolumbar Fusion For Lenke Type 5 Adolescent Idiopathic Scoliosis And The Comparison Of Clinical Outcomes Of Surgical Correction In Poliomyelitis-re

PART?The effect of surgical approaches on postoperative sagittal profile reconstruction following selective thoracolumbar fusion for Lenke type 5 adolescent idiopathic scoliosisObjective:To compare the effects of anterior or posterior selective thoracolumbar/lumbar fusion(ASF or PSF)on the reconstruction of sagittal profile in Lenke type 5 adolescent idiopathic scoliosis(AIS).Methods:A total of 102 Lenke type 5 AIS patients who underwent ASF or PSF from January 2005 to December 2010 with a minimum of 2 years follow-up were retrospectively evaluated.Fifty-six patients underwent ASF,while 46 patients underwent PSF.Pre-and postoperative radiological parameters were measured as follows:curve magnitude of thoracolumbar/lumbar(TL/L)and thoracic curve,thoracic kyphosis(TK),lumbar lordosis(LL),sacral slope(SS),sagittal vertical axis(SVA),thoracolumbar junctional kyphosis(TJK),instrumented segments angle(ISA),and proximal junctional angle(PJA).Results:The mean follow-up duration was 6.1±2.1 years and 5.3±1.5 years in ASF and PSF group respectively.Preoperative radiographic parameters and demographic data showed no significant difference between two groups.The fusion levels in ASF group were shorter than that in PSF group(5.3±0.5 vs.5.9±0.8,P<0.05),where-as the distal preserved motion segments were similar between two groups(1.8±10.7 vs.1.7±0.7,P>0.05).The correction rate of the TL/L curve was 73.2%±6.9%in ASF group and 74.8%±10.8%in PSF group at 3 month after surgery,with a3.8%±8.7%and 2.0%±0.2%of correction loss at final follow-up.Thoracic curve was corrected spontaneously in both groups,and the correction rate of TL/L and thoracic curve was similar between two groups at final follow-up.In both groups,TK increased after surgery and increased at final follow-up compared to that after surgery(P<0.05).LL decreased in ASF group after surgery(P<0.05)and remained unchanged at final follow-up.In PSF group,LL remained unchanged after surgery and increased at final follow-up compared to that after surgery(P<0.05).SS decreased after surgery in ASF group and increased at final follow-up compared to that after surgery(P<0.05).In PSF group,SS increased after surgery and increased at final follow-up compared to that after surgery(P<0.05).SVA and TJK decreased in both groups after surgery and increased at final follow up compared to that after surgery(P<0.05).ISA remained unchanged after surgery and decreased at final follow-up compared to that after surgery in ASF group(P<0.05).In PSF group,ISA increased after surgery(P<0.05)and remained unchanged at final follow-up.PJA increased after surgery in both groups,and increased at final follow-up compared to that after surgery in PSF group(P<0.05).At3 month after surgery,LL was larger in PSF group.At final follow-up,LL,ISA and PJA was significantly larger in PSF group(P<0.05).In ASF group,three patients had pseudarthrosis,one had rod breakage,three had adding-on phenomenon,and one had proximal junctional kyphosis(PJK).In PSF group,five patients had PJK and one had adding-on phenomenon.SRS-22 scores showed no significant difference between two groups.Conclusion:When Lenke type 5 AIS patients were treated with selective TL/L fusion,coronal correction could be obtained by both ASF and PSF.In sagittal plane,PSF can offer larger restoration of LL and better maintenance of lordosis in the instrumented segment than those in ASF.Additionally,the incidence of PJK in PSF group was higher than that in ASF group.PART?The comparison of clinical outcomes of surgical correction in Poliomyelitis-related spinal deformities using three types of pelvic instrumentationsObjective:We compared the clinical and radiographic outcomes of corrective surgery in patients with poliomyelitis-related spinal deformity(PSD)using 3 types of pelvic fixation and investigated the incidence and risk factors for complications.Methods:We reviewed the data from 42 patients with PSD who had undergone spinopelvic reconstruction at a single institution from 2000 to 2016.Of the 42 patients,15 had been treated with the Galveston technique,13 with iliac screw fixation,and 14 with S2-alar-iliac(S2AI)screw fixation.Demographic data,radiographic parameters,and complications were analyzed.The quality of life was determined by Scoliosis Research Society-22 questionnaires and the Oswestry Disability Index scores.Results:After surgery,the correction rate of the main curve was 51.7%,57.8%,and 52.1%in the 3 groups,with significant improvement in regional kyphosis,coronal balance,and pelvic obliquity(PO)(P<0.05).The correction of PO was similar among the 3 types of pelvic fixation;however,the patients treated with S2AI fixation required significantly less operative time(P<0.05)and blood loss(P<0.006).The overall complication rate was 40.5%,with a major complication rate of 23.8%.Age at surgery(P=0.006)and grade>? SRS-Schwab osteotomy(P=0.036)were significant risk factors for complications.25patients had the quality of life assessment at final follow-up,and significant improvement in the SRS-22 and ODI scores were observed.Conclusions:The present study showed satisfactory correction of spino-pelvic deformity for 42 patients with PSD.Compared with the Galveston technique and iliac screw fixation,the uses of S2AI significantly could decrease the operative time and estimated blood loss while obtaining similar correction of PO.Patient age at surgery and grade>? SRS-Schwab osteotomy were significant risk factors for complications.