Acta Orthop Belg. 2009 Dec;75(6):822-7.
Short segment pedicle screw fixation for unstable T11-L2 fractures: with or without fusion? A three-year follow-up study.
Hwang JH, Modi HN, Yang JH, Kim SJ, Lee SH.
Source

Division of Spine Surgery, Department of Orthopedics, Konkuk University Hospital, Seoul, South Korea.
Abstract

In unstable thoracolumbar fractures T11-L2, exaggerated kyphosis at the end of treatment may predispose to late back pain and poor functional outcome. Short-segment (SS) (3 vertebrae) pedicle instrumentation has become a popular method of treatment. However the question to add a fusion or not is still under debate. The authors retrospectively evaluated the radiological and functional results in 74 patients who had undergone an SS pedicle screw fixation. They were divided into two groups: group 1 (39 patients) was the non-fusion group; group 2 (35 patients) was the fusion group. In the non-fusion group the mean preoperative, immediate postoperative and final kyphosis angles at the fracture site were respectively 20.8 degrees +/- 6.4, 8.2 degrees +/- 4.8, and 15.2 degrees +/- 6.0. In the fusion group the corresponding angles were 26.6 degrees +/- 4.1, 7.9 degrees +/- 2.1, and 8.4 degrees +/- 2.4, which demonstrated a distinctly better final result (p < 0.0001). In the non-fusion group the preoperative, immediate postoperative and final follow-up visual analog scores (VAS) for back pain were respectively 7.3 +/- 0.8, 3.9 +/- 0.8, and 3.4 +/- 0.9. In the fusion group the corresponding scores were 7.5 +/- 1.0, 3.9 +/- 1.1, and 1.6 +/- 0.7; the final result pleaded again in favour of fusion (p < 0.0001). Moreover, there were significantly more implant-related complications (screw loosening and breakage) in the non-fusion group (p < 0.0001). The authors conclude that fusion is advisable to obtain a better final outcome with respect to kyphosis and pain, and to avoid implant-related complications. However, at least one other study has led to the opposite conclusion: the issue remains controversial.

Spine (Phila Pa 1976). 2011 Jun 15;36(14):1146-53.
Posterior multilevel vertebral osteotomy for severe and rigid idiopathic and nonidiopathic kyphoscoliosis: a further experience with minimum two-year follow-up.
Modi HN, Suh SW, Hong JY, Yang JH.
Source

Department of Orthopedics, Scoliosis Research Institute, Korea University Guro Hospital, Seoul, South Korea.
Abstract
STUDY DESIGN:

Prospective randomized study.
OBJECTIVE:

To evaluate the clinica! and radiologic outcome of posterior multilevel vertebral osteotomy (PMVO) in patients with severe kyphoscoliosis.
SUMMARY OF BACKGROUND DATA:

Authors have developed and reported results of PMVO for correction of neuromuscular scoliosis. PMVO has advantages such as, posterior-only procedure which avoids risk to pulmonary complications and gives satisfactory correction. However, its effect in correcting severe scoliosis in presence of rigid kyphosis has not been reported.
METHODS:

Thirteen patients (7 idiopathic, 4 cerebral palsy, and 2 congenital scoliosis) with severe and rigid kyphoscoliosis were operated by posterior-only correction with pedicle screw fixation using PMVO. As per pathology, and associated severity of kyphosis little modification in the original technique was applied while correction and osteotomy. Neuromonitoring was applied in all patients during operation. The radiologic and clinical results were evaluated with an average follow-up of 42.9±11 months. All postoperative complications were also noted during the follow-up period.
RESULTS:

Average number of osteotomy was 4.2±0.8 (range, 3-5). Average preoperative Cobb angle, pelvic obliquity, thoracic kyphosis, and lumbar lordosis were 99.2°±29.6°, 8.6°±9°, 73.6°±56.9°, and -47.2°±63.2°, respectively, which improved after surgery to 44.7°±12.3°, 2.8°±2.9°, 45.3°±15.9°, and -47.7°±12.2°. All corrections were maintained at final follow-up. A 54.3% correction was achieved in coronal plane; and, full correction was achieved in sagital plane as thoracic kyphosis was restored within normal range. Average blood loss and operative time was 3015±1213 mL and 6.01±1.09 hours, respectively. Three patients had postoperative respiratory complications; 2 had hemothorax and 1 had atelectasis; none had follow-up consequences. All pulmonary complications were due to associated thoracoplasty during which pleura was ruptured intraoperatively. Two patients had complication related with the implants; 1 screw breakage and other screw prominence. There was no neurologic injury intraoperatively on motor-evoked po- tentials (MEP) or clinically after surgery.
CONCLUSION:

PMVO exhibited satisfactory clinical and radiologic results in patients with severe and rigid scoliosis associated with hyperkyphosis at minimum 2-year follow-up. It can be safely applied with modifications in original technique for complex congenital scoliosis with multilevel hemi or block vertebrae and idiopathic/nonidiopathic spinal deformities.

Eur Spine J. 2011 Jul;20(7):1087-94. Epub 2011 Jan 28.
Idiopathic scoliosis in Korean schoolchildren: a prospective screening study of over 1 million children.
Suh SW, Modi HN, Yang JH, Hong JY.
Source

Scoliosis Research Institute, Department of Orthopedics, Korea University Guro Hospital, 80 Guro-Dong, Guro-Gu, Seoul, South Korea.
Abstract

Cross-sectional epidemiologic scoliosis screening was carried out to determine the current prevalence of scoliosis in the Korean population and to compare with the results of previous studies. Between 2000 and 2008, 1,134,890 schoolchildren underwent scoliosis screening. The children were divided into two age groups, 10-12-year-olds (elementary school) and 13-14-year-olds (middle school), to calculate age- and sex-specific prevalence rates. Children with a scoliometer reading ≥5° were referred for radiograms. Two surgeons independently measured curve types, magnitudes, and Risser scores (inter-observer r = 0.964, intra-observer r = 0.978). Yearly and overall prevalence rates of scoliosis were calculated. There were 584,554 boys and 550,336 girls in the sample, with a male to female ratio of 1.1:1. There were 77,910 (6.2%) children (26,824 boys and 51,086 girls) with scoliometer readings >5°, and 37,339 of them had positive results with Cobb angles ≥10° (positive predictive value, 46.4%). The overall scoliosis prevalence rate was 3.26%; girls had a higher prevalence (4.65%) than boys (1.97%). Prevalence rates increased progressively from 1.66 to 6.17% between 2000 and 2008, with the exception of 2002. According to age and gender, 10-12-year-old girls had the highest scoliosis prevalence rates (5.57%), followed by 13-14-year-old girls (3.90%), 10-12-year-old boys (2.37%), and 13-14-year-old boys (1.42%). In girls and boys, prevalence rates dropped by 64.53 and 60.65% among 10-12-year-olds and 13-14-year-olds, respectively (P = 0.00). The proportion of 10°-19° curves was 95.25 and 84.45% in boys and girls, respectively; and the proportion of 20°-29° curves was 3.91 and 11.28%, which was a significant difference (P = 0.00). Thoracic curves were the most common (47.59%) followed by thoracolumbar/lumbar (40.10%), double (9.09%), and double thoracic (3.22%) curves. A comparison of the curve patterns revealed significant differences between genders (P = 0.00). We present this report as a guide for studying the prevalence of idiopathic scoliosis in a large population, and the increasing trend in the prevalence of idiopathic scoliosis emphasizes the need for awareness.