Are more screws better? A systematic review of anchor density and curve correction in adolescent idiopathic scoliosis

被引：54

作者：

Larson A.N. ^{[1
]}

Aubin C.-E. ^{[2
]}

Polly Jr. D.W. ^{[3
]}

Ledonio C.G.T. ^{[3
]}

Lonner B.S. ^{[4
]}

Shah S.A. ^{[5
]}

Richards III B.S. ^{[6
]}

Erickson M.A. ^{[7
]}

Emans J.B. ^{[8
]}

Weinstein S.L. ^{[9
]}

机构：

[1] Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN 55905

[2] Department of Mechanical Engineering, Polytechnique Montreal, Montreal, QC H3T1C5, P.O. Box 6079, Downtown Station

[3] Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN 55454

[4] Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY 10017

[5] Department of Orthopedics, Nemours/Alfred I. DuPont Hospital for Children, Wilmington, DE 19899

[6] Department of Orthopedics, Texas Scottish Rite Hospital for Children, Dallas, TX 75219

[7] Department of Orthopedic Surgery, Children's Hospital, Aurora, CO 80045, 13123 E. 16th Avenue

[8] Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA 02115

[9] Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA 55242

来源：

Spine Deformity | 2013年 / 1卷 / 4期

基金：

加拿大自然科学与工程研究理事会; 美国国家卫生研究院;

关键词：

Anchor point; Curve correction; Implant; Scoliosis; Screw;

D O I：

10.1016/j.jspd.2013.05.009

中图分类号：

学科分类号：

摘要：

Study Design: Systematic review of clinical studies. Objectives: To critically evaluate existing literature to determine whether increased anchor or implant density (screws, wires, and hooks per level fused) results in improved curve correction for adolescent idiopathic scoliosis (AIS) surgery. Summary of Background Data: Wide variability exists in the number of screws used for AIS surgery. High numbers of pedicle screws are increasingly used, but there is limited evidence to support this as best practice. Methods: Online English-language databases were searched to identify articles addressing anchor density. Articles were reviewed for anchor type/number, radiographic measures, and patient-reported outcomes. Results: Of 196 references identified, 10 studies totaling 929 patients met the inclusion criteria. Reported mean anchor density varied from 1.06 to 2.0 implants per level fused. Mean percent coronal curve correction varied from 64% to 70%. Two studies (463 patients) analyzed hook, hybrid (combined hooks and screws), and screw constructs as a single cohort. Both found increased correction with high-density constructs (p =.01, p <.001), perhaps as a result of the hooks and hybrid constructs. Eight retrospective studies and 1 prospective randomized, controlled trial had predominantly screw constructs (466 patients). Increased anchor density was not associated with improved curve correction. The studies evaluating screw density are significantly underpowered to detect a difference in curve correction. Conclusions: Wide heterogeneity in anchor density exists in the surgical treatment of AIS. Reports evaluating the effects of increased anchor density are mostly retrospective and significantly underpowered to detect a difference in curve correction and patient outcomes. At this time, there is insufficient evidence to show that anchor density affects clinical outcomes in AIS. © 2013 Scoliosis Research Society.

引用

页码：237 / 247

页数：10

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