الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Adolescent Idiopathic Scoliosis (AIS) is a 3D deformity of the spine for which no cause can be established, and occur between the age of 10 and skeletal maturity. It is a diagnosis of exclusion, where other possible causes are eliminated.
In scoliosis, it is important to not only assess the curvature in the coronal and sagittal planes but to also quantify the rotation deformity occurring in the transverse plane. The rotation is maximal at the apical vertebra and it is primarily responsible for the rib hump that represents the main cosmetic problem for adolescent patients. Measurement of vertebral rotation is of key significance in the prognosis and treatment of scoliotic curves.
Effectively realigning vertebrae that have rotated out of position is a process called derotation, which has been the most difficult part of the deformity to correct, and it is more important than only correcting coronal deformity.
This prospective study is conducted to evaluate the efficacy of vertebral derotation using SCRR maneuver in the treatment of patients with Adolescent Idiopathic Scoliosis (AIS) by clinical and radiological follow up for 1 year.
In this study, we conducted prospective analysis on 30 patients with AIS, who underwent one stage posterior only
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corrective surgery with SCRR maneuver between 2016 and 2019 at Ain Shams University hospitals in order to correct their deformities. All patients included in this study had idiopathic curve between 40 and 80 degrees, with flexibility index < 50%, and their ages were between 10 and skeletal maturity.
Assessment of the patients included history, physical examination, preoperative and 1 year postoperative radiographic evaluation by plain X-rays, CT and MRI to assess Cobb angle, RVAD, RA at the apical vertebra, evaluation by SRS-22 questionnaire and patient satisfaction. Intraoperatively, assessment of the operation time and amount of bleeding was done. Neuro-physiological monitoring was provided to all patients.
Based on comparative review with other articles using the same technique, our study included patients with relatively large curve magnitude and the lowest flexibility index, had average coronal correction rate by about 65.5% and minimal correction loss during follow up (-1°). Furthermore, our study included the largest mean preoperative RA. The axial correction rate was average (32.7%) and has the lowest complication rate and better clinical outcome and patient satisfaction among other studies that used SCRR maneuver.
However, the mean operating time in our series in the present study was longer than the mean operating time in the
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literature. The mean amount of blood loss in our study was more than the mean amount in other studies.
On the other hand, shortcomings of this study include the following: short duration of follow up (1 year), large amount of blood loss (1400 ml), relatively long operative time (321 min) and doing the preoperative and postoperative CT in supine position as this reduces the RA.
Simple concave rod rotation is a good option for correction of the deformed curve in AIS. We can state that simple concave rod rotation with pedicle screw instrumentation and without the use of DVD maneuver could successfully correct both coronal and axial deformity with minimal complication. Adding DVD technique offers a better correction of apical vertebra rotation.