Dr. Jason Lowenstein Featured in “Top 100 Classic Papers on Adolescent Idiopathic Scoliosis”

Over the past 25 years, surgical researchers have made drastic advances in the sphere of surgical scoliosis correction. Industrious researchers have invented sophisticated new surgical hardware, broadened the scope of non-surgical treatment options, and published fascinating papers on adolescent idiopathic scoliosis. In honor of these life-altering achievements, the Spinal Deformity Journal has released an article ranking the top 100 classic papers on adolescent idiopathic scoliosis.

We’re pleased to announce that Dr. Jason Lowenstein’s 2007 article (“Coronal and sagittal plane correction in adolescent idiopathic scoliosis—a comparison between all pedicle screw versus hybrid thoracic hook lumbar screen constructions”) made the list at #21, a monumental achievement considering the hundreds upon hundreds of articles written on this topic.

Dr. Jason Lowenstein is an industry-leading expert in the field of spinal deformity care who specializes in unusually complex cases of adult and pediatric scoliosis. In addition, Dr. Lowenstein is a founding member of the Advanced Spine Center and serves as its medical director of spinal deformity.

Even at a glance, Dr. Lowenstein’s medical credentials are impressive. He completed his undergraduate degree in neuroscience at the University of Pennsylvania where he graduated magna cum laude. Subsequently, Dr. Lowenstein went on to earn his medical degree at the University of Pittsburgh School of Medicine, before finally pursuing a residency in orthopedic surgery at the Columbia University Medical Center in New York.

Today, we are celebrating this great success by reviewing Dr. Lowenstein’s abstract from his 2007 paper. Specifically, we’ll explain why this landmark study was so impactful in the field of pediatric orthopedics.

A Comparison Between Two Types of Surgical Hardware

The goal of this study was to retrospectively examine the efficacy of two different types of treatment across a series of 34 cases. Researchers treated one group of 17 patients using all pedicle screws while the other 17 pursued relief through hybrid thoracic hook lumbar screw constructs.

Up until this point, contemporary research suggested that all-screw constructs were more effective than hybrid constructs in correcting spinal deformities. However, Dr. Lowenstein’s retrospective cohort study found that this wasn’t actually the case. In fact, both methods ended up being just as effective as one another.

Dr. Lowenstein’s team arrived at this conclusion by examining any potential differences between the two groups of patients—the all screw construct group vs. the hybrid construct group. While they did find that there was a slightly better correction of thoracic curves in the all-screw construct group, the difference between the two was not statistically significant enough to warrant one being designated as decisively better than the other. The results were as follows:

  • The mean thoracic kyphosis decreased from 29.6 degrees to 19.4 degrees in the all-screw group.
  • In the hybrid group, the sagittal balance changed from -21.2 mm to 8.2 mm.
  • For the all-screw group, the sagittal balance changed from -28.8 mm to 1.5 mm.
  • The major curve in the hybrid group improved from 64.06 degrees to 20.25 degrees
  • Meanwhile, the major curve in the all-screw group changed from 54.88 degrees to 15.06 degrees.

This now meant that surgeons were vindicated in pursuing hybrid screw models in patients who may be better served by them, whether for anatomical reasons or otherwise.

What Does It Mean To Be A “Classic?”

In many cases, it’s difficult to determine whether something has achieved “classic” status until decades after it has reached the public. Consider this: Van Gogh only sold two paintings in his lifetime and now you can find his masterpieces in their own dedicated museum.

It’s impressive, then, that Dr. Lowenstein’s 13-year-old article has already achieved “classic” status in the eyes of a respected publication. While some contemporary works of art and science may be considered an instant classic, the term classic in and of itself usually suggests that an item withstands the test of time.

However, Dr. Lowenstein’s 2007 article challenged an idea proposed by widely accepted clinical research. His retrospective examination decisively proved the efficacy of both all-screw constructs AND hybrid constructions. This discovery armed surgeons with crucial knowledge—namely, that both of these treatment options were now viable choices for addressing adolescent idiopathic scoliosis.

When it comes to treating your body, it is vitally important to have options. For example, there may be cases in which one type of screw is a more appropriate choice than the other. Before, we would have always come to the default conclusion—the status quo. With Dr. Lowenstein’s study, we now have more options available to us for treating scoliotic curves.

I Need Spinal Instrumentation: What Option Is Best For Me?

Obviously, there is no simple answer to this question. Your best option for instrumentation will depend upon the specifics of your case. While your doctor will present you with all of the available options, luckily, you won’t really need to worry too much about this question. Your doctor will be able to give their expert and informed opinion on which route you should take when it comes to reversing your scoliotic curves.

Typically, your surgeon will use spinal hardware in conjunction with fusion surgery. This is a very common procedure and it may or may not involve some of the hardware discussed above. Generally speaking, your doctor will use spinal hardware to enhance your spinal stability while you heal from your surgical procedure. This may include all-screws, hybrid constructs, or a variety of plates, rods, and cages.

You might be concerned about having metal hardware in your body. Don’t worry too much though. These items are designed to be left in the body for long periods of time. Typically, they are made of cobalt-chrome, stainless steel, or the even more contemporary titanium.

Whether or not you feel the hardware in your spine after your surgery is somewhat up in the air, but it is generally uncommon to feel anything. Some patients don’t notice any perceivable differences after their fusion, while a small minority may notice changes during cold weather months.

Contact Us

Have you had painful or uncomfortable symptoms in your back for a period of two weeks or more? Have you tried more conservative treatment options but to no avail? If so, you may want to consider giving our office a call at (855) 220-5966.

Dr. Jason Lowenstein is a board-certified, fellowship-trained scoliosis surgeon who will ensure that you receive the finest standard in scoliosis correction. Don’t let your negative symptoms keep you from being able to live your life to the fullest. Give us a call as soon as you can!