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Simultaneous Dual Rod Correction and Direct Vertebral Rotation Technique to Correct Double Major Adolescent Idiopathic Scoliosis Curve

March 01, 2017

Contributors: Raffaele Borghi, MD; Mohammadreza Chehrassan, MD; Daniele Fabbri, MD; Fabrizio Perna; Federico Pilla, MD; Camilla Pungetti, MD; Niccolò Stefanini, MD; Angelo Toscano, MD; Francesco Traina, MD, PhD; Cesare Faldini, MD; Cesare Faldini, MD

Keywords: Scoliosis

2017 AWARD WINNER Adolescent idiopathic scoliosis is a three-dimensional deformity of the spine that occurs in children older than 10 years at the time of diagnosis but before skeletal maturity. Deformity of the scoliosis should be considered and corrected in three planes: the frontal, sagittal, and axial planes. This video shows the surgical technique for correction of a double major scoliosis deformity in a 14-year-old girl with normal kyphosis and a type C lumbar modifier. In patients with a double major curve, a major thoracic structural curve and a minor thoracolumbar or lumbar structural curve exist. Axial rotation of the vertebrae and ribs induce the rib hump deformity in the thoracic region and thoracolumbar passage, which require particular attention at the time of vertebral rotation. To correct the deformity in all three planes, the technique is performed via simultaneous dual rod application and direct vertebral rotation. Simultaneous rod application and derotation may improve correction in the frontal and sagittal planes. The latter can be expected as a result of distribution of the force on two rods rather than one. In addition, applying two rods with different bending contours to lessen kyphosis on the convex side and overbending at the level of the apical vertebrae on the concave side may improve correction in the axial plane at the time of rod reduction. Typically, direct vertebral rotation is performed to reduce the rib hump deformity; however, it also may decrease the extension of fusion. Direct vertebral rotation should be performed by applying several rotation tubes, which distributes the force on various pedicle screws and reduces the risk of pullout of pedicle screws at the time of rotation. In our experience, simultaneous dual rod application and direct vertebral rotation to correct double major adolescent idiopathic scoliosis results in excellent correction in all three planes without any major complications.

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