Early radiological and functional outcomes following posterior spinal instrumentation in non-degenerative structural scoliosis: A single-center retrospective study

Öz

Aim: Posterior spinal instrumentation using segmental pedicle screw systems is a widely accepted surgical technique for the treatment of non-degenerative structural scoliosis because of its ability to achieve effective three-dimensional deformity correction and provide biomechanical stability. This study aimed to evaluate the early radiological and functional outcomes of posterior spinal instrumentation in patients with non-degenerative structural scoliosis. Material and Methods: This retrospective single-center study included patients who underwent posterior spinal instrumentation for non-degenerative structural scoliosis between January 2025 and May 2026. Demographic, radiological, and clinical data were reviewed retrospectively. Preoperative and postoperative Cobb angles were compared, and deformity correction rates were calculated. Early postoperative functional outcomes were assessed using the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) at the 3-month follow-up. Results: Twenty-five patients with a mean age of 15.28 ± 3.29 years were included. In patients with available preoperative and postoperative radiographic measurements, the mean Cobb angle decreased significantly from 58.42 ± 18.54° preoperatively to 13.29 ± 11.06° postoperatively (p < 0.001). The mean deformity correction rate was 78.78 ± 13.31%. At the 3-month follow-up, the mean VAS and ODI scores were 3.96 ± 1.99 and 25.28 ± 10.00, respectively. Adult patients demonstrated significantly higher ODI scores than pediatric patients (p = 0.042). Perioperative complications occurred in three patients (12.0%). Conclusion: Posterior-only segmental pedicle screw instrumentation achieved a mean deformity correction rate of nearly 80%, providing satisfactory early radiological correction and favorable short-term functional outcomes.

Anahtar Kelimeler

• Scoliosis
• posterior spinal instrumentation
• pedicle screw fixation
• Cobb angle
• functional outcome

Non-degeneratif yapısal skolyozda posterior spinal enstrümantasyon sonrası erken dönem radyolojik ve fonksiyonel sonuçlar: Tek merkezli retrospektif bir çalışma

Öz

Amaç: Segmental pedikül vida sistemleri kullanılarak uygulanan posterior spinal enstrümantasyon, üç boyutlu deformite düzeltmesini etkin şekilde sağlayabilmesi ve biyomekanik stabilite sunması nedeniyle non-dejeneratif yapısal skolyozun cerrahi tedavisinde yaygın olarak kullanılan bir yöntemdir. Bu çalışmanın amacı, non-dejeneratif yapısal skolyoz nedeniyle posterior spinal enstrümantasyon uygulanan hastalarda erken dönem radyolojik ve fonksiyonel sonuçları değerlendirmektir. Gereç ve Yöntemler: Bu retrospektif tek merkezli çalışmaya, Ocak 2025 ile Mayıs 2026 tarihleri arasında non-dejeneratif yapısal skolyoz nedeniyle posterior spinal enstrümantasyon uygulanan hastalar dahil edildi. Demografik, radyolojik ve klinik veriler geriye dönük olarak incelendi. Ameliyat öncesi ve sonrası Cobb açıları karşılaştırıldı ve deformite düzeltme oranları hesaplandı. Erken dönem fonksiyonel sonuçlar, ameliyat sonrası 3. ay kontrollerinde değerlendirilen Görsel Analog Skala (VAS) ve Oswestry Özürlülük İndeksi (ODI) skorları kullanılarak analiz edildi. Bulgular: Çalışmaya yaş ortalaması 15,28 ± 3,29 yıl olan 25 hasta dahil edildi. Ameliyat öncesi ve sonrası radyografik ölçümleri mevcut olan hastalarda ortalama Cobb açısı ameliyat öncesi 58,42 ± 18,54° iken ameliyat sonrası 13,29 ± 11,06°’ye geriledi (p < 0,001). Ortalama deformite düzeltme oranı %78,78 ± 13,31 olarak bulundu. Üç aylık takipte ortalama VAS ve ODI skorları sırasıyla 3,96 ± 1,99 ve 25,28 ± 10,00 idi. Erişkin hastalarda ODI skorları pediatrik hastalara göre anlamlı derecede daha yüksekti (p = 0,042). Perioperatif komplikasyon üç hastada (%12,0) görüldü. Sonuç: Posterior segmental pedikül vida enstrümantasyonu, non-dejeneratif yapısal skolyozlu hastalarda yaklaşık %80 oranında deformite düzeltmesi sağlayarak tatmin edici erken dönem radyolojik düzelme ve olumlu kısa dönem fonksiyonel sonuçlar sunmaktadır.

Anahtar Kelimeler

• Skolyoz
• posterior spinal enstrümantasyon
• pedikül vida fiksasyonu
• Cobb açısı
• fonksiyonel sonuç.

Kaynakça

1. Weinstein SL, Dolan LA, Cheng JC, Danielsson A, Morcuende JA. Adolescent idiopathic scoliosis. Lancet. 2008;371(9623):1527-1537. https://doi.org/10.1016/S0140-6736(08)60658-3
2. Cheng JC, Castelein RM, Chu WC, Danielsson AJ, Dobbs MB, Grivas TB, et al. Adolescent idiopathic scoliosis. Nat Rev Dis Primers. 2015;1:15030. https://doi.org/10.1038/nrdp.2015.30
3. Konieczny MR, Senyurt H, Krauspe R. Epidemiology of adolescent idiopathic scoliosis. J Child Orthop. 2013;7(1):3-9. https://doi.org/10.1007/s11832-012-0457-4
4. Asher M, Min Lai S, Burton D, Manna B. The reliability and concurrent validity of the Scoliosis Research Society-22 patient questionnaire for idiopathic scoliosis. Spine (Phila Pa 1976). 2003;28(1):63-69. https://doi.org/10.1097/00007632-200301010-00015
5. Negrini S, Donzelli S, Aulisa AG, Czaprowski D, Schreiber S, de Mauroy JC, et al. 2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis Spinal Disord. 2018;13:3. https://doi.org/10.1186/s13013-017-0145-8
6. Suk SI, Lee SM, Chung ER, Kim JH, Kim SS. Selective thoracic fusion with segmental pedicle screw fixation in the treatment of thoracic idiopathic scoliosis: more than 5-year follow-up. Spine (Phila Pa 1976). 2005;30(14):1602-1609. https://doi.org/10.1097/01.brs.0000169452.50705.61
7. Kim YJ, Lenke LG, Bridwell KH, Cho YS, Riew KD. Free hand pedicle screw placement in the thoracic spine: is it safe? Spine (Phila Pa 1976). 2004;29(3):333-342. https://doi.org/10.1097/01.BRS.0000109983.12113.9B
8. Liljenqvist U, Lepsien U, Hackenberg L, Niemeyer T, Halm H. Comparative analysis of pedicle screw and hook instrumentation in posterior correction and fusion of idiopathic thoracic scoliosis. Eur Spine J. 2002;11(4):336-343. https://doi.org/10.1007/s00586-002-0415-9

9. Lenke LG, Bridwell KH, Baldus C, Blanke K. Preventing decompensation in King type II curves treated with Cotrel-Dubousset instrumentation: strict guidelines for selective thoracic fusion. Spine (Phila Pa 1976). 1992;17(8 Suppl):S274-S281. https://doi.org/10.1097/00007632-199208001-00011
10. Newton PO, Faro FD, Gollogly S, Betz RR, Lenke LG, Lowe TG. Results of preoperative pulmonary function testing of adolescents with idiopathic scoliosis: a study of six hundred and thirty-one patients. J Bone Joint Surg Am. 2005;87(9):1937-1946. https://doi.org/10.2106/JBJS.D.02209
11. Sarıgül B, Öğrenci A, Aydın L, Öndüç G, Ramazanoğlu AF, Dalbayrak S. Exact lumbar anterior epidural injection via extreme lateral approach: A novel technique and clinical outcomes. Med J West Black Sea. 2025;9:361-369. https://doi.org/10.29058/mjwbs.1790377
12. Özer Mİ, Demirtaş OK, Çulcu Z, Sözer A, Solmaz İ. Unilateral biportal endoscopy versus microscopic discectomy for far-lateral lumbar disc herniations: A retrospective comparative study. Med J West Black Sea. 2025;9:354-360. https://doi.org/10.29058/mjwbs.1781834
13. Watanabe K, Lenke LG, Bridwell KH, Kim YJ, Hensley M, Koester L. Efficacy of perioperative halo-gravity traction for treatment of severe scoliosis (≥100°). J Orthop Sci. 2010;15(6):720-730. https://doi.org/10.1007/s00776-010-1523-8
14. Dobbs MB, Lenke LG, Kim YJ, Kamath G, Peelle MW, Bridwell KH. Selective posterior thoracic fusions for adolescent idiopathic scoliosis: comparison of hooks versus pedicle screws. Spine (Phila Pa 1976). 2006;31(20):2400-2404. https://doi.org/10.1097/01.brs.0000240212.31241.8e
15. Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine (Phila Pa 1976). 2000;25(22):2940-2952. https://doi.org/10.1097/00007632-200011150-00017
16. Pishnamaz M, Migliorini F, Blume C, Kobbe P, Trobisch P, Delbrück H, et al. Long-term outcomes of spinal fusion in adolescent idiopathic scoliosis: a literature review. Eur J Med Res. 2024;29(1):534. https://doi.org/10.1186/s40001-024-02052-7
17. Jabbouri SS, Joo P, David WB, Jeong S, Moran J, Jonnalagadda A, et al. Pre-contoured patient-specific rods result in superior immediate sagittal plane alignment than surgeon contoured rods in adolescent idiopathic scoliosis. J Spine Surg. 2024;10(2):177-189. https://doi.org/10.21037/jss-24-1
18. Bridwell KH, Glassman S, Horton W, Shaffrey C, Schwab F, Zebala LP, et al. Does treatment (nonoperative and operative) improve the two-year quality of life in patients with adult symptomatic lumbar scoliosis: a prospective multicenter evidence-based medicine study. Spine (Phila Pa 1976). 2009;34(20):2171-2178. https://doi.org/10.1097/BRS.0b013e3181a8fdc8
19. Schwab F, Patel A, Ungar B, Farcy JP, Lafage V. Adult spinal deformity-postoperative standing imbalance: how much can you tolerate? An overview of key parameters in assessing alignment and planning corrective surgery. Spine (Phila Pa 1976). 2010;35(25):2224-2231. https://doi.org/10.1097/BRS.0b013e3181ee6bd4