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Use of All-pedicle-screw Constructs in the Treatment of Adolescent Idiopathic Scoliosis

Dr. Cuartas is Chief Resident, Department of Orthopaedics and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL. Dr. Rasouli is Spine Fellow, Department of Orthopaedics and Rehabilitation, University of Miami Miller School of Medicine. Dr. O’Brien is Orthopaedic Surgeon, Department of Orthopaedic Surgery, Miami Children’s Hospital, Miami. Dr. Shufflebarger is Director, Division of Pediatric Spinal Surgery, Miami Children’s Hospital.

Dr. O’Brien or a member of his immediate family has received royalties from DePuy and Medtronic Sofamor Danek, and is a member of a speakers’ bureau or has made paid presentations on behalf of, serves as a paid and unpaid consultant to or is an employee of, and has received research or institutional support from DePuy. Dr. Shufflebarger or a member of his immediate family has received royalties, research or institutional support, and nonincome support (such as equipment or services), commercially derived honoraria, or other non–research-related funding (such as paid travel) from DePuy Spine; is a member of a speakers’ bureau or has made paid presentations on behalf of DePuy; and serves as a paid and unpaid consultant to or is an employee of DePuy. Neither of the following authors nor a member of their immediate families has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Cuartas and Dr. Rasouli.

Reprint requests: Dr. Cuartas, Department of Orthopaedics and Rehabilitation, University of Miami Miller School of Medicine, 1611 NW 12th Avenue, D27, Miami, FL 33136-1005.

All-pedicle-screw constructs are safe and biomechanically advantageous in the management of adolescent idiopathic scoliosis. Safe and reproducible placement of thoracic pedicle screws is dependent on a thorough understanding of normal and abnormal anatomy, meticulous technique, and the use of neuromonitoring and fluoroscopy. Improvement in the biomechanical properties secondary to the use of pedicle screw fixation has led to shorter fusions with improved deformity correction. Coronal, sagittal, and rotational correction is superior to that obtained with hook instrumentation. Improved derotation may decrease the need for thoracoplasty, thus eliminating the risk of associated morbidity. Superior control of the deformity with all-pedicle-screw fixation, as well as the use of adjunctive posterior releases, often obviates the need for an anterior approach, even in severe curves measuring 70° to 100°. Improved correction, shorter fusion, and the lower morbidity associated with posterior-only approaches may compensate for higher implant costs.