Anterior Technique:
Hodgson(2) reported the first large series of patients undergoing anterior spine surgery in 1958 from Hong Kong. These were patients with spinal tuberculosis with an associated kyphosis. In addition to drug treatment, these patients had their spine approached anteriorly, all infected bone removed, and a bone graft inserted into a slot in the upper and lower vertebrae to bridge the area where bone had been removed. The patients were kept in a cast until the graft had healed. Hodson’s results were quite good and his article describes in detail, approaches to the anterior aspect of the spine.

ANTERIOR INSTRUMENTATION TECHNIQUES

DWYER
Dwyer(1), an Australian, developed the first anterior spine instrumentation system, publishing his work in 1966. After removing the discs over the area to be fused, a titanium staple was placed over each vertebrae and a screw was placed through the staple and across the vertebrae. This was done on the convex side of the curve. Bone graft was placed in each disk space, a woven cable was placed through an eye in the screw heads, and a compressive load applied. It was possible to obtain a very nice correction of both the scoliosis and the associated rotation. The problems were that in spite of external support the spines tended to drift into kyphosis and there was a high breakage rate of the cable.

ZIELKE
Zielke(5), a German, described the use of a solid threaded rod in 1976. The kyphosis and breakage were less than with the Dwyer system, but still occurred.

TSRH
The staff at the Texas Scottish Rite Hospital(4) in Dallas described the use of larger (3/16"or 1/4") solid rod in 1993. This has largely eliminated the problems of kyphosis and rod breakage seen with the earlier anterior systems. Because of the degree of correction that can be obtained and the small number of vertebrae that need to be fused, often only three or four, this has become the preferred treatment by many orthopaedists for curves that have their apex at the junction of the thoracic and lumbar spine. One problem that has been associated with its use is an occasional non-union at the lowest instrumented level.

KANEDA
Kaneda(3), from Japan, described in 1996 the use of a dual anterior rod system. Two screws are placed through a staple in each vertebral body and then a rods are secured to the screws. It appears that this system may be rigid enough to eliminate the problem of a non-union and that it may also be possible to obtain some permanent lordosis.

1Dwyer, M.B., Newton, N.C., and Sherwood, A.A. An Anterior Approach to Scoliosis. Clinical Orthopaedics and Related Research. 62: 192-202, 1969.

2Hodgson, M.B., Stock, F.E. Anterior Spinal Fusion. British J. Surg. 44: 266-275, 1956.

3Kaneda, K., Shono, Y., Satoh, S., Abumi, K. New Anterior Instrumentation for The Management of Thoracolumbar and Lumbar Scoliosis. Spine 21 (10): 1250-1262, 1996.

4Turi, M., Johnston, C.E., and Richards, B.S. Anterior Correction of Idiopathic Scoliosis Using TSRH Instrumentation. Spine 18 (4): 417-422, 1993.

5Zielke, K., Stunkat, R., and Beaujean, F. Ventral Derotation Spondylodesis. Arch. Orthop. Unfallchii 85 (3): 257-260, 1976.

You are here: Home > Overview of Surgical Treatment of Adolescent Idiopathic Scoliosis > Anterior Technique