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Suk, Chung, Kim, Lee, Lee, Lee, Kim, and Park: Prevention of the Crankshaft Phenomenon with Posterior Pedicle Screw Fixation in Scoliosis of the Skeletally-Immature Spine
Original Research

Journal of Korean Spine Surg 2003;10(1):55-63.

Published online: 18 December 2003

DOI: https://doi.org/10.7469/JKSS.2003.10.1.55

Prevention of the Crankshaft Phenomenon with Posterior Pedicle Screw Fixation in Scoliosis of the Skeletally-Immature Spine

Se-Il Suk, M.D., Ewy-Ryong Chung, M.D., Jin-Hyok Kim, M.D., Sang-Min Lee, M.D., Ji-Ho Lee, M.D.∗, Jung-Hee Lee, M.D.∗∗, Sung-Soo Kim, M.D., Joon-Suk Park, M.D.

Seoul Spine Institute, Inje University Sanggye Paik Hospital

∗Department of Orthopaedic Surgery, Boramae Municipal Hospital

∗∗Department of Orthopaedic Surgery, Hallym University

Address reprint requests to Ewy-Ryong Chung, M.D. Seoul Spine Institute, Inje University, Sanggye Paik Hospital, Sanggye 7-dong, Nowon-gu, Seoul 139-707, Korea Tel: 82-2-950-1284, Fax: 82-2-3302-1101, E-mail: dragon@sanggyepaik.ac.kr

Copyright © 2003 Korean Society of Spine Surgery

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

A retrospective study.

Objectives

To evaluate the results of posterior segmental pedicle screw fixation in skeletally immature patients with scoliosis.

Summary of Literature Review

Scoliosis correction, in the immature spine, frequently necessitates additional anterior surgery to prevent the crankshaft phenomenon. With the advent of posterior segmental pedicle screw fixation, it is unclear whether an additional anterior procedure will be required.

Material and Methods

Seventeen scoliosis patients (10 idiopathic, 4 congenital and 3 others; 3 males and 14 females) were treated with segmental pedicle screw fixation only. Their results were reviewed for a deformity progression of more than 10○, and evidence of adding- on. A ll the patients had a 0 Risser rib vertebra angle difference (RVAD) progression of more than 10 index at the time of the operation. The mean age and follow- up times were 10.4, ranging from 7.2 to 11.8 years old, and 4.0, ranging from 3.0 to 5.4 years, respectively.

Results

The mean preoperative thoracic curve of 55° was corrected to 22 (58% correction) at last follow-up and the non-structural lumbar curve of 31° was corrected to 10° (67% correction) at last follow-up. Preoperative thoracic kyphosis of 28° structural lumbar curve of 31○○, preoperatively and postoperatively, respectively. No ○ was improved to 34 at last follow- up. The RV A D were 23 and 13○ or more in the postoperative coronal curve or RVA D. One patient had a progression of the patient showed a progression of 10 deformity caudal to the instrumented segments. There were no neurological or screw- related complications.

Conclusions

Posterior segmental pedicle screw fixation in skeletally immature patients with scoliosis may be effective in pre-venting the crankshaft phenomenon.

Keywords: Idiopathic scoliosis, Crankshaft phenomenon, Segmental Pedicle screw fixation, Immature spine

REFERENCES

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Fig. 1.
Case 9. 10.5-year-old girl with juvenile idiopathic scoliosis. She was during her peak height velocity at operation, and had closed triradiate cartilage. Fig. 1 A, B. Preoperative anteroposterior and lateral radiographs showed 88° of main thoracic and 50° of proximal thoracic curve. Preoperative RVAD was 31°. Fig. 1.C, D. Anteroposterior and lateral radiographs taken 1 month after operation. Main thoracic curve and proximal thoracic curve were corrected to 27° and 23°, respectively. RVAD was 27°. Fig. 1.E. F. Anteroposterior and lateral radiographs taken 4 year after operation. Main thoracic curve and proximal thoracic curve were 28° and 25°, respectively. RVAD was 24°. In serial radiographs, there was neither curve nor RVAD progression more than 10°.
jkss-10-55f1.tif
Table 1.
Patient data.
Patient No. Age at operation Sex Diagnosis TRC PHV Curve Fusion Levels
1 7.2 F CS Open Prior MT T8-T11
2 8.8 M NMS Open Prior MT T3-S1
3 8.9 F CS Open Prior MT T1-T4
4 9.6 F CS Closed Past MT C7-T4
5 9.8 F JIS Closed During MT T2-L2
6 10.1 F Homocystinuria Open During MT T3-L1
7 10.2 F JIS Closed Past MT T5-L3
8 10.4 F JIS Closed Past MT T4-T12
9 10.5 F JIS Closed During PT T1-T5
            MT T5-L1
10 10.8 F AIS Closed Past MT T4-T12
11 11.2 F AIS Closed During MT T3-L2
12 11.3 F JIS Closed Past MT T2-L2
13 11.4 M AIS Open Prior MT T4-L1
14 11.5 F NFS Open Prior PT T2-T7
            MT T7-L1
15 11.6 F AIS Open During PT T1-T6
            MT T6-L1
16 11.8 M JIS Closed Prior PT T2-T8
            MT T8-L2
17 11.8 F CS Open Past PT T1-T7
            MT T7-L2

TRC: triradiate cartilage, PHV: peak height velocity, CS: congenital scoliosis NMS: neuromuscular scoliosis, NFS: neurofibromatosis scoliosis, JIS: juvenile idiopathic scoliosis AIS: adolescent idiopathic scoliosis, MT: main thoracic, PT: proximal thoracic

Table 2.
Cur rve magnitude an nd rib vertebra a angle differen nce.
Patient No. Curve Cobb (°) RVAD (°)
Pre IMPO PO 1 yr Last Pre IMPO PO 1 yr Last
1 MT 23 20 22 23 18 13 14 18
2 MT 50 8 9 10 12 10 6 2
3 MT 35 27 25 20 25 12 10 5
4 MT 52 32 30 38 15 12 13 15
5 MT 75 20 22 16 31 25 26 17
6 MT 86 33 36 37 65 45 42 43
7 MT 65 39 44 44 6 4 4 4
8 MT 55 10 11 9 10 9 4 6
9 PT 50 23 23 25 20 13 6 4
  MT 88 27 29 28 31 27 23 24
10 MT 61 19 22 23 40 30 23 23
11 MT 58 5 6 4 21 5 2 4
12 MT 51 8 15 16 10 10 8 8
13 MT 48 9 10 10 37 18 12 10
14 PT 40 14 11 13 26 11 8 12
  MT 57 24 20 19 32 27 30 30
15 PT 47 19 20 25 15 6 14 15
  MT 46 9 12 13 18 2 3 5
16 PT 49 16 20 20 13 15 17 12
  MT 48 15 20 24 12 7 8 2
17 PT 57 42 45 42 6 5 4 6
  MT 68 22 27 25 34 15 14 20

IMPO: Immediate postoperative measures were made from radiographs taken 1 month after surgery. RVAD: rib vertebra angle difference of Mehta

Table 3.
Results.
  Preoperative Immediate Postoperative 1 year Follow up Last Follow up
Thoracic curve∗ (°) 55.0± 15.1 20.0± 10.3 21.8± 10.5 22.0± 10.8
  (Correction)   (62%) (59%) (58%)
Lumbar curve (°) 30.7± 10.6 7.9± 6.2 9.0± 6.8 10.0± 7.4
  (Correction)   (74%) (71%) (67%)
Thoracic kyphosis (°) 27.8± 13.6 29.5± 8.0 31.3± 8.0 34.4± 10.5
Lumbar lordosis (°) 49.5± 8.6 49.0± 5.2 50.5± 5.7 52.0± 9.1
Coronal balance (mm) 19.9± 20.0 3.5± 3.3 2.9± 4.2 3.2± 3.9
  (Imbalance) (10/17) (0/17) (1/17) (1/17)
AVT (mm) 29.2± 27.0 3.7± 6.2 4.2± 5.2 5.2± 5.7
RVAD∗ (°) 22.6± 13.9 14.5± 10.4 13.2± 10.2 13.0± 10.4
Thoracic hump (mm) 26.5± 15.0   13.3± 8.9 13.6± 9.5

IMPO: Immediate postoperative measures were made from radiographs taken at discharge after surgery AVT : apical vertebral translation RVAD : rib vertebra angle difference of Mehta

∗ No patient had a 10° or more progression in the serial radiographs after operation

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