Three Column Fixation: A Dynamic Method in Scoliosis Surgery. Issue 1 (April 2016) - Alam, Shah
Introduction: Scoliosis is a complex three dimensional deformity characterized by coronal, sagittal and horizontal plane deviation. Non operative treatment is a widely accepted approach. A significant number of cases need surgical intervention. Revolutionary design & capability of spinal instruments have drastically changed the principle of scoliosis correction by surgical intervention. Material and Methods: During the period February 2009 to November 2014, 64 cases of different types of Scoliosis underwent surgical intervention at NITOR, BSOH and other private hospitals in Dhaka. 45 were female and 19 were male and age ranged from 14 to 38 years. Results: The pedicle is a power nucleus of the vertebra and offers a secure grip of all 3 columns. Pedicle screw instrumentation has advantages of rigid fixation with improved 3D correction and it has been accepted as a reliable method with a high margin of safety. Accurate placement of the pedicle screws is important to reduce possible irreversible complication. So, all cases were corrected by transpedicular screws and rods and 1 case stabilized by sub laminar wring. 61 cases were managed by only posterior approaches and 3 cases required both anterior releases, costoplasty, posterior stabilization as well. In every case fusion was done in selected segments. Conclusion: Total follow up time was ~5 years (6 months-5yrs). All patients were assessed in terms of correction of deformities, cosmesis, and functional outcome. 64 patients had average coronal plane cobb's angle measuring ~70 degree pre-operatively and 17.12 degree immediate post-operative period. 4 patients (5.7%) developed neurological deficit. 3 regained completely but another one regaining her neurological deficit very slowly. There were malposition of screws in 9 (14%) cases, Painful prominence of screws in 6 cases (9%), full flexion lack in 8 cases (12.5%) & superficial infection in 1 case (1.5%). 80% patients improved cosmetically.