Executive Editor: Kenneth Cheung, Larry Lenke General Editor: German Ochoa

Authors: Han Jo Kim, Marinus de Kleuver, Keith Luk

Adolescent Idiopathic Scoliosis Lenke 1

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Glossary

1 Introduction top

AIS Adiopathic adolescent scoliosis Anterior release posterior fixation Lenke 1 1 Aim of surgery enlarge

The aims of surgery are to:

  • improve the spinal curve,
  • improve the three dimensional alignment of the spine,
  • prevent progression of the curve in the future
  • improve cosmesis
  • reduce pain
  • optimize pulmonary function
  • maintain neurological integrity.

This is achieved by correction of the deformity and creation of a solid arthrodesis of the deformed part of the spine.

To illustrate this procedure, we will use a right thoracic curve.

2 Approaches top

AIS Adiopathic adolescent scoliosis Anterior release posterior fixation Lenke 1 enlarge

The endoscopically assisted anterior release is performed through standard portals of the anterior thoracoscopic approach .


AIS Adiopathic adolescent scoliosis Anterior release posterior fixation Lenke 1 enlarge

The instrumentation is performed through a posterior approach. The lengths of the incision will depend on the levels being fused.

3 Anterior release top

AIS Adiopathic adolescent scoliosis Anterior release posterior fixation Lenke 1 Anterior release enlarge

Anterior release

The anterior release consists of a thorough discectomy and resection of annulus of the apical intervertebral discs within the proposed instrumented area of the spine.

Generally a minimum of 3-4 apical intervertebral discs are excised.


AIS Adiopathic adolescent scoliosis Anterior release posterior fixation Lenke 1 Discectomy enlarge

The annulus is incised from the lateral aspect of the spine with a scalpel. The disc is removed using curettes and rongeurs. 

Removal of the posterior annulus is optional.


AIS Adiopathic adolescent scoliosis Anterior release posterior fixation Lenke 1 enlarge

The anterior longitudinal ligament is usually not cut during this procedure and helps to protect the instruments from damaging the anterior vessels.


AIS Adiopathic adolescent scoliosis Anterior release posterior fixation Lenke 1 Annulus enlarge

Removal of the posterior annulus

Due to limitation of visualization, care should be taken to excise the posterior annulus if deemed necessary. Excision of the rib head will further improve flexibility and aid in the exposure and excision of the posterior annulus. 


AIS Adiopathic adolescent scoliosis Anterior release posterior fixation Lenke 1 Excision of cartilaginous end plates enlarge

Excision of cartilaginous end plates

The cartilaginous end plate is excised using a curette, a periosteal elevator or a chisel in order to reduce the risk of pseudoarthrosis. 

4 Arthrodesis top

AIS Adiopathic adolescent scoliosis Anterior release posterior fixation Lenke 1 Arthrodesis enlarge

Morselized rib graft supplemented with bone substitutes or iliac crest bone graft is placed in the interbody spaces.

5 Posterior instrumentation top

Further posterior release, facet joint fusion and instrumentation proceed according to the standard description of the posterior alone procedures. 

Posterior procedures

v1.0 2013-12-07