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Preventing the crankshaft phenomenon by combining anterior fusion with posterior

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Spine. 1995 Jun 15;20(12):1392-8. Related Articles, Links

Preventing the crankshaft phenomenon by combining anterior fusion

with posterior instrumentation. Does it work?

Lapinksy AS, s BS.

Texas ish Rite Hospital, Dallas, USA.

STUDY DESIGN. Fourteen skeletally immature patients with idiopathic

scoliosis (Group I) were retrospectively studied to determine if the

crankshaft phenomenon was prevented by combining anterior spinal

fusion with posterior instrumentation and fusion. They were compared

with 12 similar patients who underwent posterior procedures only

(Group II). OBJECTIVES. To determine whether the addition of

anterior spinal fusion was beneficial in preventing progressive

spinal deformity in the very young patient.

SUMMARY OF BACKGROUND DATA. The crankshaft phenomenon had been well

documented in young patients undergoing posterior fusion only. No

previous study compared the results of a similar group of patients

some of whom underwent combined anterior and posterior fusion and

the others who underwent posterior fusion only.

METHODS. Patients who were Risser O and had open triradiate

cartilages at surgery were evaluated for curve correction,

correction loss, changes in rib vertebral angle differences,

rotational changes, and spinal balance. Crankshaft was defined as a

progression in curve magnitude greater than 10 degrees and

accompanied by an increase in rib vertebral angle difference greater

than 10 degrees. In Group I, age at surgery averaged 10.7 years, and

follow-up averaged 37 months. In Group II, age at surgery averaged

11.0 years, and follow-up averaged 64 months.

RESULTS. Group I: Thoracic curve correction averaged 77% after

surgery and 68% at follow-up. At follow-up, two patients had curves

progress more than 10 degrees, and three patients had an increase in

rib vertebral angle difference of 10 degrees or more, but none of

the patients had these changes simultaneously. Group II: During the

course of follow-up, five of the 12 patients had progressive changes

of 10 degrees or more in curve size and rib vertebral angle

difference. Four other patients had an increase exceeding 10 degrees

in one of the two categories.

CONCLUSIONS. In skeletally immature children (open triradiate

cartilage and Risser O) with idiopathic scoliosis, the addition of

anterior spinal fusion to posterior instrumentation and fusion is

helpful in preventing the crankshaft phenomenon.

PMID: 7676338 [PubMed - indexed for MEDLINE]

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