Radiographic and Functional Outcome in Adolescent Idiopathic Scoliosis Operated With Hook/Hybrid Versus All-Pedicle Screw Instrumentation-A Retrospective Study in 149 Patients.

Abstract

Retrospective cohort study. To compare radiographic outcome and health-related quality of life in patients with adolescent idiopathic scoliosis (AIS) treated with hook/hybrid (H/H) or all-pedicle screw (PS) instrumentation. PS instrumentation has largely replaced H/H in the surgical treatment of AIS but whether a normalized sagittal profile can be obtained with the PS construct is still debated. Additionally, comparative studies assessing HRQL and surgical complications are needed. Two consecutive series of surgically treated AIS patients were included. Surgical treatment consisted of H/H or low-profile all-PS instrumentation. Radiographic and clinical follow-up, including SRS-22r questionnaires, was performed a minimum of two years postoperatively. There were 85 and 64 patients in the H/H and PS group, respectively. The groups did not differ on baseline parameters apart from a lower flexibility in the H/H group (34% ± 14% vs. 39% ± 14% in the PS group, p = .026). Mean curve correction at final follow-up was 31% ± 13% versus 49% ± 12% in the H/H and PS group, respectively (p < .001), and mean loss of correction was 7° versus 4° (p < .001). The Cincinnati correction index was significantly higher in the PS group at final follow-up (p < .001). Postoperative thoracic kyphosis was significantly higher in the H/H group (27° ± 11° vs. 22° ± 11° in the PS group) with a mean change in kyphosis of 3° ± 9° versus -3° ± 12° in the H/H and PS group, respectively. SRS-22 scores did not differ between the two groups (p > .090), and the reoperation rate at final follow-up was 9% in the H/H group and 6% in the PS group (p = .556). In a large consecutive cohort of AIS patients followed for a minimum of two years, we found a significantly better curve correction and less loss of correction with PS instrumentation compared to H/H. There was no significant difference in SRS-22r scores at final follow-up. Level III.