Rheumatology: Current Research
Open Access

Apical derotation in scoliosis, the concept of internal splinting

International Conference and Exhibition on Orthopedics & Rheumatology

August 13-15, 2012 Hilton Chicago/Northbrook, USA

Wichien Laohacharoensombat

Scientific Tracks Abstracts: Rheumatology & Orthopedics

Abstract :

T he evolution of spinal fixation have been dramatically progressed since the era of Harrington in the 1950s. Dwyer introduced the anterior derotation in scoliosis around the 1960s which was modified and popularized by the Zielke-VDS system. Cotrel- Dubousset and Guillaumat reported the technique of derotation by the posterior rods and hooks 1n 1977 followed by a variety of pedicle screws and rods instrumentations which currently are regarded as a gold standard of fixation in scoliosis. We have routinely practiced the technique of apical derotation by the plate and screw system with the standard decortication of the lamina without additional bone graft. in Ramathibodi Hospital since 1995. The annual rate for the operation of AIS is 10- 20 per year. By 2005, we gradually found out the system is stable enough to maintain the correction without external supporting brace, however bracing is maintained in those cases of very young age group to control the secondary un-operated segments. Within a few years of randomized control trials, those cases with and without decortication showed no differences in implant survival and maintenance of correction stability. Recently the concept of internal splinting has been introduced along with shorter fixation segment. The routine fixation for a common right thoracic curve is putting the screws in T5,T6,T7,T10,T12 and L1 ( T11 and T12) on the convex side whereas on the concave side, the screws are situated in T8, T9, T10 ,T11 andT12 utilizing the spinolaminar part of the T5 and L1 as the footing for the plate. The common fixation segment in thoracolumbar curve is from T10-L2. In those cases of very young children (under 5 years) with progressive congenital scoliosis, the outcome of unilateral minimal fixation on the convex side only is on the process of long term evaluation. Some cases of junctional scoliosis has been recognized in those cases with inappropriately too short fixation, some of which need extension fusion