Cureus · 2026
Outcome of Correction of Adolescent Idiopathic Scoliosis by the Axial Translational Technique With a Pedicle-Screw-and-Rod Construct.
СтатьяНазвание и аннотация: Перевод в очереди
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Mahmud Md Rajib, Rahman A H M Masiur, Mahmud Golam, Rahman Sk Muhammad Atiqur, Hossain Nadia, Sarker Shagor Kumer, Kamruzzaman Md, Rahman Al Amin
Аннотация
BACKGROUND: Adolescent idiopathic scoliosis (AIS) is the most common form of spinal deformity encountered in paediatric orthopaedic practice, and surgical correction with posterior pedicle-screw constructs has become the reference standard for curves progressing beyond conservative thresholds. The axial translational technique (ATT) relies on sequential derotation and translation of the deformed spine toward a pre-contoured rod, avoiding the forceful segmental manoeuvres that characterise older cantilever and direct-rotation methods. Data describing this technique from South Asian centres remain limited.
METHODS: We conducted a single-centre, prospective quasi-experimental study at the National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka, between September 2021 and March 2024. Adolescents aged 10-18 years with a confirmed diagnosis of AIS and a major Cobb angle greater than 45° were consecutively enrolled. All patients underwent posterior instrumentation and fusion using the ATT with polyaxial pedicle screws and a pre-bent 5.5 mm titanium rod. The primary outcomes were the change in the main-curve Cobb angle and thoracic kyphotic angle from baseline to 12 months post-operatively. Secondary outcomes were standing height, visual analogue scale (VAS) pain score, the Scoliosis Research Society-22 (SRS-22) questionnaire, and functional grading by Modified Macnab criteria. Paired t-tests and chi-square tests were used as appropriate; a two-sided P-value of less than .05 was considered statistically significant.
RESULTS: Fifteen patients were analysed (mean age 14.13 ± 2.06 years; 60.0% female). Mid-thoracic curves predominated (53.3%), and Lenke type 1 was the most frequent pattern (53.3%). The mean Cobb angle was corrected from 59 ± 7° to 10 ± 2° (mean absolute correction 48.8 ± 5.83°, 83% correction; P < .001). Thoracic kyphosis improved from 9 ± 2° to 34.2 ± 3.43° (P < .001), representing restoration toward the physiological range. The VAS score fell from 5.73 ± 0.77 to 1.40 ± 0.48 at 12 months (P < .001), and standing height increased by a mean of 3 cm (P < .001). All SRS-22 domains improved significantly (P < .001). Functional outcome by Modified Macnab criteria was Excellent in 9 patients (60.0%), Good in 4 (26.7%), and Fair in 2 (13.3%); no patient was graded Poor. Nine screws in three patients (20.0%) were radiographically misplaced on post-operative computed tomography without clinical sequelae; three patients (20.0%) developed superficial wound infection that resolved with oral antibiotics.
CONCLUSIONS: The ATT with pedicle-screw-and-rod instrumentation produced substantial three-dimensional correction of AIS with a favourable safety profile and meaningful gains in pain, appearance, and health-related quality of life at one year. These findings support its use as a reproducible correction strategy in resource-constrained tertiary centres.
METHODS: We conducted a single-centre, prospective quasi-experimental study at the National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka, between September 2021 and March 2024. Adolescents aged 10-18 years with a confirmed diagnosis of AIS and a major Cobb angle greater than 45° were consecutively enrolled. All patients underwent posterior instrumentation and fusion using the ATT with polyaxial pedicle screws and a pre-bent 5.5 mm titanium rod. The primary outcomes were the change in the main-curve Cobb angle and thoracic kyphotic angle from baseline to 12 months post-operatively. Secondary outcomes were standing height, visual analogue scale (VAS) pain score, the Scoliosis Research Society-22 (SRS-22) questionnaire, and functional grading by Modified Macnab criteria. Paired t-tests and chi-square tests were used as appropriate; a two-sided P-value of less than .05 was considered statistically significant.
RESULTS: Fifteen patients were analysed (mean age 14.13 ± 2.06 years; 60.0% female). Mid-thoracic curves predominated (53.3%), and Lenke type 1 was the most frequent pattern (53.3%). The mean Cobb angle was corrected from 59 ± 7° to 10 ± 2° (mean absolute correction 48.8 ± 5.83°, 83% correction; P < .001). Thoracic kyphosis improved from 9 ± 2° to 34.2 ± 3.43° (P < .001), representing restoration toward the physiological range. The VAS score fell from 5.73 ± 0.77 to 1.40 ± 0.48 at 12 months (P < .001), and standing height increased by a mean of 3 cm (P < .001). All SRS-22 domains improved significantly (P < .001). Functional outcome by Modified Macnab criteria was Excellent in 9 patients (60.0%), Good in 4 (26.7%), and Fair in 2 (13.3%); no patient was graded Poor. Nine screws in three patients (20.0%) were radiographically misplaced on post-operative computed tomography without clinical sequelae; three patients (20.0%) developed superficial wound infection that resolved with oral antibiotics.
CONCLUSIONS: The ATT with pedicle-screw-and-rod instrumentation produced substantial three-dimensional correction of AIS with a favourable safety profile and meaningful gains in pain, appearance, and health-related quality of life at one year. These findings support its use as a reproducible correction strategy in resource-constrained tertiary centres.