Fusionless Correction of Moderate Adolescent Idiopathic Scoliosis with a New Minimally Invasive Dynamic Implant (ApiFix®) and Postoperative Schroth Scoliosis Specific Exercises-Case Series

The standard surgical management of AIS is spinal fusion. Nonfusion solutions for addressing moderate AIS curves are desirable. ApiFix® is a new posterior dynamic device consisting of an expandable ratcheting rod anchored by two pedicle screws to the concave side of the scoliotic spine. It was designed to address single, moderate Lenke type 1 or 5 curves. Surgery is performed without the addition of spine fusion of the instrumented segments. The surgical procedure is short with negligible blood loss and rapid recovery. Deformity correction is achieved by distraction leading to rod elongation. Curve correction is achieved not only during surgery but also after the surgical procedure by performing scoliosis specific exercises. These exercises activate the ratchet with further rod expansion and curve reduction. The reported cases demonstrate the efficacy of the combined approach of surgery and exercises in controlling moderate AIS. This clinical experience with the ratchet device shows consistent curve improvement and stabilization. It lends support to the concept that surgery with this new posterior dynamic device may be a viable alternative to fusion and or as an internal brace in non-compliant brace users for managing moderate AIS curves.