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An anterior thoracoabdominal approach
37%
1528/4142
Preoperative Cobb angle of 60 degrees
20%
811/4142
Age greater than 35 years
30%
1239/4142
A posterior midline approach
5%
199/4142
Positive sagittal balance < 5 cm
8%
339/4142
Select Answer to see Preferred Response
In the surgical treatment of adult idiopathic scoliosis, a thoracoabdominal approach has been shown to have higher rates of pseudoarthrosis compared to posterior procedures. Raizman et al reviewed pseudoarthrosis in spinal patients. Multiple factors, including smoking, kyphosis >20 degrees, positive sagittal balance greater than 5cm, preexisting hip arthritis, age greater than 55, and a throacoabdominal approach were determined to be significant risk factors. Kim et al retrospectively analyzed 144 patients who underwent spinal instrumentation and fusion to S1 at a minimum of a 2-year follow-up. Factors that significantly affected achieving a successful fusion were hip arthritis, age greater than 55 years, and incomplete sacropelvic fixation. Figures A and B are standing scoliosis films in the coronal and sagittal plan showing a patient with adult idiopathic scoliosis. Incorrect Answers: Answer 2: A Cobb angle of 60 degrees has not been shown to correlate with pseudoarthrosis. Answer 3: Age greater than 55 years is associated with an increased rate of pseudoarthrosis. Answer 4: A posterior approach with fusion to the upper thoracic spine has not been shown to correlate with pseudoarthrosis. Answer 5: Positive sagittal balance greater than 5 cm is associated with an increased rates of pseudoarthrosis.
1.9
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