Getting best possible correction for scoliosis and spine surgery. Good question from Liz.

Liz,
That is a good article, but kinda old — really was addressing a couple different ways of getting correction with CD system with hooks.

There are basically 10 things that you can do to enhance and/or improve scoliosis and kyphosis correction in adolescents or adults:

1. Use screws rather than hooks for whole construct.  Screws give better “hold” and are more lateral, enhancing correction.
2. Using more points of fixation — in some cases  two pedicle screws at every vertebral body level.
3. Osteotomies / bone wedges to free up and allow more correction.  Big osteotomies, including vertebral column resection (VCR) are also possible, but are much more invasive.
4. Using stronger rod, like Cobalt Chrome, which holds it shape better.
5. Rod Rotation ( as mentioned in the article you shared)
6. Translation (mentioned in article) -- I use some special “Pursuader” tools that allow me to do this in a very special and powerful way to get better correction.
7. Compression and/or distraction of individual segments.
8. How you contour the rods.
9. What levels you choose to fuse.
10. Correcting with two rods at the same time as opposed to traditional one rod at a time technique (our  method)
    

How you combine all of these various “tools” is where the art and experience comes in.

There is a bunch of literature out there, as well as lots of abstracts / presentations from Scoliosis Research Society that I have at my office.
We’re in the process of writing up my series of scoliosis patients using the combination of all nine techniques above, with our special dual rod  pursuader technique, which I’ve developed over past 2 years.

Here’s a couple articles you might find helpful:

1. http://www.medscape.com/viewarticle/448311_2
2. http://www.spineuniverse.com/professional/pathology/deformity/adolescent-idiopathic-scoliosis-treated-posterior
   

I can get you more if needed.
You are going to have your PhD in Scoliosis Surgery!  Should help you as a Scoliosis Buddy some day!

Hope this answers your question.

Take care,

Dr. Lloyd Hey
Hey Clinic for Scoliosis and Spine Surgery
http://www.heyclinic.com


On 5/7/10 6:52 PM, "Liz" <> wrote: 

re the cd method vs yours, does this article (I realize it's old) articulate the differences between the two different method's techniques for derotating the spine?  (rotation maneuver vs a translation maneuver)?  If not, do you have any literature on how your method is the best of breed?  I totally trust you that it is, but I'd love to read up on it if you can steer me in the right direction.  Sorry I have been flooding your inbox as of late. 

http://journals.lww.com/spinejournal/Abstract/1999/10010/Intraoperative_Comparison_of_Two_Instrumentation.9.aspx