Vertebral Derotation in Adolescent Idiopathic Scoliosis

https://doi.org/10.1053/j.oto.2009.04.001Get rights and content

The treatment of adolescent idiopathic scoliosis has evolved substantially over the years. Early designs, such as the Harrington rod, corrected coronal deformity but failed to account for normal sagittal alignment. Cotrel-Dubousset instrumentation allowed for better control of sagittal contours such as thoracic kyphosis and lumbar lordosis while maintaining coronal deformity correction. However, rotational control of scoliosis remained poor. Modern instrumentation systems with pedicle screws allow for the first time the possibility of true rotational correction, but this requires more than simple rod derotation maneuvers. Instead, a method of directly applying rotational force to a screw that has 3-column purchase is required in order to effect a derotation of individual vertebra. This is accomplished through the advent of direct vertebral rotation devices. We describe the technique to use these devices to perform rotational correction of scoliotic deformities later in the text.

Section snippets

Surgical Technique

We position our scoliosis patients prone on a Jackson table. A midline incision is made over the levels to be fused and meticulous exposure of the posterior elements is performed out to the tips of the transverse processes. The inferior articular facets at each thoracic level are osteotomized with a narrow osteotome to increase the flexibility of the spine and expose the superior articular facet. Exposing the superior articular facet allows for thorough removal of the cartilaginous surface to

Conclusion

With the initial introduction of the revolutionary CD instrumentation 25 years ago, the quest for optimal 3-dimensional scoliosis correction continues. The combination of periapical thoracic pedicle screws undergoing a bilateral apical vertebral derotation technique using modern instrument sets is the next evolution in the CD philosophy. DVR devices provide not only optimal periapical vertebral manipulation but also marked correlative correction of thoracic and lumbar rib prominences without

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