Non-fusion anterior scoliosis correction (NFASC) as an alternative to fusion to stabilise progressive idiopathic scoliosis in skeletally mature children with double sided curve is “promising” but longer-term data are needed, new research suggests.
The results of a prospective study, which was presented by Umesh Kanade (Apollo Hospitals, Chennai, India), at the British Association of Spine Surgeons (BASS) 2022 meeting (23–25 March 2022; Belfast, UK), showed that double sided NFASC provided 67% correction for the main thoracic (MT) curve (54° to 17.4°) and 68% correction for the thoracolumbar/lumbar (TL/L) curve (53.5° to 17.4°) at two-year follow-up with no major complications.
It also showed that staging procedure and postoperative pain management with epidural reduces opioid consumption, improves pain scores and reduces length of stay (LOS).
“Long-term outcomes of large series documenting the ideal candidate for surgery, ideal curve characteristics, ideal timing of surgery, and magnitude of intraoperative curve correction will be critical for this novel technique to reduce the reoperation rate or convert into fusion surgery,” say the researchers.
The study was co-authored by Keyur Akbari and Vigneshwara Badikillaya (Chennai, India), and hypothesised that the application of novel NFASC in skeletally mature children (Risser ≥4 and Sanders ≥7) with double sided adolescent idiopathic scoliosis (AIS) curves done through a staged procedure reduces respiratory complications, cord breakage, postoperative opioid consumption and reduced LOS.
The research team conducted a prospective analysis of 10 skeletally mature AIS patients with double curves who underwent NFASC with a minimum of two-year follow-up. Pertinent clinical and radiographic data collected included skeletal maturity, curve type, Cobb angle, sagittal parameters, and patient-reported outcome measure SRS-22 questionnaire.
A total of nine females and one male were included in the cohort, with a mean age of 15.2 ± 1.52 years (range: 13-21 years). Mean Sanders score was 7.3 ± 0.4 and mean Risser score was 4.1 ± 0.3. There were five patients in each Lenke 3 and Lenke 6. Cranial and caudal instrumentation levels were T5 and L4.
The mean blood loss was 102.3 ± 10.4ml, and the mean operative time was 169.0 ± 14.2 minutes. The average LOS was 4.5 ± 1.01 days. Mean preoperative MT and TL/L Cobbs were 54°± 6° and 53.5° ± 10.9°, which were corrected to 18° ± 3.4° (66% correction) and 15.3° ± 2.4° (70% correction) respectively.
At two-year follow up, the MT and TL/L curves were stabilised at 17.4° ± 2.6° and 16.5° ± 1.5° respectively. No neurologic, cardiopulmonary related, and or implant related complications were recorded. Mean SRS-22 scores pre-op and post-op were 3.5 ± 0.3 and 4.5 ± 0.1, respectively (p<0.01).
Main lead behind the research, and someone who Akbari notes was “a pioneer in introducing this technique to southeast Asia”, is Sajan Hegde (Chennai, India). Speaking to Spinal News International, Hegde said: “Thirty years ago, when I was starting my career in spine surgery, I was fortunate to work with legends Daniel Chopin (Lille, France) and Jürgen Harms (Saarbrücken, Germany). Cotrel-Dubousset instrumentation was then taking the spine world by storm in the early 90s. Today, I see the same excitement with the revolutionary new concept of non-fusion anterior scoliosis correction (NFASC).
“To date, we have used this new technique on 76 patients. Fortunately, we have not faced any short-term or long-term complications, including tether breakage, except in one patient who had pneumothorax post-surgery immediately addressed with intercostal drainage.
“I strongly believe NFASC will change the way we treat Lenke 5 (thoracolumbar/lumbar) curves as well as Lenke 3 and Lenke 6 (double curves).”