Abstract
Introduction
The authors show their experience with the use of Daytona instrumentation in the treatment of pediatric spine deformities. In the correction maneuvers it is important to build up clusters that are groups of pedicle screws joined together for stability in the derotation and provide greater force in the correction and also to prevent the hypokyphosis effect of all screw construct in the scoliosis correction.
Materials and Methods
Our department used the Daytona system in 81 patients with pediatric scoliosis since March 2011. The Daytona instrumentation is a novel instrumentation that uses pedicle screws with long tulips in their basic construction. The screws are uniplanar or polyaxial and the tulips are 30 mm long, which makes it much easier to put the rod in the construction without the need of a persuader and helps in the initial correction maneuver. The caps are specially designed to embrace the rod and prevent splaying of the screw during the tightening and untightening. The scoliosis correction maneuver that we used were rod derotation, derotation of the spine with groups of screws (cluster), “in situ” bending, compression and distraction, and segmental derotation. Using the clusters, there are less chances of screw pullout and splaying. Generous Ponte osteotomies are important for spine flexibility and better correction. We use Lenke's classification for the classification of scoliosis. We analyze the follow-up time, curve angles, flexibility, and the Cincinnati index. For patients with idiopathic scoliosis, we use the SRS 22r outcomes questionnaire.
Results
Retrospectively, we analyze 81 patients with scoliosis, 64 female and 17 male, with a mean age of 13.96 years (10–17 years). A total of 88% of the patients had idiopathic scoliosis. Others are neuromuscular and syndromic patients. Preoperatively, the mean angle was 78.09 degrees (38–120 degrees) and the mean flexibility index was 30.7%. Postoperatively, the mean angle was 23.6 degrees (5–62 degrees). Correction percentage was 68.1% and the Cincinnati index was 3.33%. The mean follow-up time was 16.9 months, at last follow-up the mean curve angle was 24.7 degrees, representing a loss to the postoperative period of 5% of loss of correction. The most frequent complications that we encounter were temporary loss of MEP and screw breakage. Comparing with the literature, the Daytona system is as effective as other systems in the market.
Conclusion
The Daytona instrumentation is a very good system for the treatment of adolescent idiopathic scoliosis; it is as effective as other systems with the added advantage of being much easier to place in the patient, and with the cluster technique we can save money with fewer screws and the derotation maneuver with clusters is a powerful correction technique.