Sequential Rod Rolling for Surgical Correction of Lenke Type 2 Adolescent Idiopathic Scoliosis: A 3D Analysis.
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2025-07
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Introduction
Many options have been described to restore balance and create stable fusion in severe adolescent idiopathic scoliosis (AIS), including preoperative gravity halo traction, posterior vertebral column resection, and three column osteotomies. Unfortunately, each of these comes with risks of excess bleeding or neurological injury. The sequential rod rolling (SRR) technique uses a short stiff rod to distract and derotate the main thoracic (MT) curve, followed by a second full length rod on the opposite side to distract and derotate the proximal thoracic (PT) curve and finally a short rod on the convexity of the PT to offer a controlled correction of rigid deformities. The aim of this investigation is to describe the technique, its indications, the rotational correction achieved, and the complications observed when it is used in the treatment of severe pediatric AIS.Materials and method
A retrospective study was carried out to include all patients treated with SRR to manage a Lenke 2 curve between 2006 and 2018, in whom a 3D EOS reconstruction was available. The primary objective of this study was to measure the derotation of the apical vertebra of the PT achieved by the sequential rod technique. The secondary objectives include defining the morbidity and complications observed.Results
Sixteen patients with a mean age of 15 years were included. The mean pre-operative coronal angular deformity was 53° for the PT and 76° for the MT. The mean post-operative coronal angular deformity was 19° for the PT, 22° for the MT. The mean rotation preoperatively was 10° for the apical vertebra of the PT and 23° for the MT. The mean rotation postoperatively was 3° for the apical vertebra of the PT and 8° for the MT. Twelve patients had a 2-year post-operative follow-up. No proximal junctional kyphosis or complications were reported at the 2-year follow-up.Conclusion
This data show that SRR achieves a mean coronal PT correction of 66% and 72% for the MT curve. The average derotation is 7° for the PT and 15° for the MT. No complications were encountered. The SRR technique for Lenke 2 type AIS seems to be, according this study a safe and effective technique.Type
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Nallet, Jérémie, Brett Rocos, David Eduard Lebel, Wafa Skalli, Reinhard Zeller and Rajendra Sakhrekar (2025). Sequential Rod Rolling for Surgical Correction of Lenke Type 2 Adolescent Idiopathic Scoliosis: A 3D Analysis. Journal of orthopaedic case reports, 15(7). pp. 282–287. 10.13107/jocr.2025.v15.i07.5850 Retrieved from https://hdl.handle.net/10161/34876.
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Brett Rocos
I joined the team at Duke University Health in 2022 from London, UK, where I was a Consultant Adult and Paediatric Spine Surgeon at Barts Health NHS Trust and Honorary Consultant Senior Lecturer at Queen Mary University of London. I completed my surgical training in in the South West of the UK and at the University of Toronto, and am fellowship trained in adult spine surgery, paediatric spine surgery, orthopaedic trauma surgery, research and healthcare management.
I am driven to support patients at every stage of their care, from clinic assessment, through surgery to discharge. Making sure that every person, adult, child, family or friend understands what’s wrong, helping them to choose the right treatment for them, and what the recovery will be like is an important priority.
My research activity focusses on finding effective new treatments for spinal disorders and bringing them to patients. Focusing on spinal deformity, I have led investigations in the UK, Canada and the USA, and I sit on the Global AO Knowledge Forum for Deformity, the International Spine Study Group and the Research Grants Committee at the Scoliosis Research Society. I have lectured in North America and Europe about the treatment of spine disorders for the Scoliosis Research Society, Global Spine Congress, AO Spine and Eurospine, and I have worked hard to produce research that improves the care for spine patients wherever they live. Lastly, I review for several orthopaedic journals and am a recent Deputy Editor of the Bone and Joint 360, a leading publication with a global readership.
I welcome collaborations across academic settings and departments, and maintain opportunities for studnets at all stages of training to become part of a clinical and research team.
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