J Am Acad Orthop Surg, Vol 17, No 9, September 2009 Esteban Cuartas, MD, Alexandre Rasouli, MD, Michael OBrien, MD and Harry L. Shufflebarger, MD
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.