Zielke Instrumentation

The appeal of the anterior VDS approach was that, for certain curves in the lower part of the spine, working from the front allowed excellent correction and derotation while fusing fewer segments than an equivalent posterior operation — potentially preserving more movement in the lower back. For selected thoracolumbar and lumbar idiopathic curves it could give very good correction of both the sideways curve and the rotation. This made it an attractive option in its era for a specific group of patients.

The main weakness of the original Zielke system was mechanical. It relied on a single threaded rod, which was relatively slender and prone to two related problems: it could allow the treated segment to fall into unwanted kyphosis (a forward-bending deformity), and the rod itself could break before the fusion had solidified. These were well-recognised drawbacks. The response was to strengthen the construct: dual-rod modifications, such as the Halm-Zielke system, were developed specifically to overcome the instability and rod-breakage problems of the single-rod design, and these gave more reliable results. This progression — from single rod, to dual rod, to modern anterior and posterior systems — is a clear example of how a technique's limitations drove its own improvement.

The published experience with Zielke VDS, and with its dual-rod refinements, showed good correction of thoracolumbar and lumbar curves, with the dual-rod versions addressing the kyphosis and breakage issues of the original. Studies also examined the effect of anterior surgery on lung function, an important consideration whenever the chest is entered to reach the spine from the front. Taken together, the evidence supports Zielke instrumentation as an effective technique of its time for selected curves, with recognised limitations in its original single-rod form that later designs improved upon.

Adults treated with Zielke or Halm-Zielke instrumentation for a thoracolumbar or lumbar curve are often stable and well many years later. If you have this instrumentation and develop new pain, a change in your posture, or symptoms that concern you, assessment by a surgeon experienced in adult and revision deformity is the right step. I do not use Zielke instrumentation; my aim here is to explain the technique honestly and to signpost appropriate specialist care.

• —Zielke K, et al. Arch Orthop Unfallchir. 1976. Original description of ventral derotation spondylodesis. PMID 949288
• —Zielke K. Beitr Orthop Traumatol. 1978. VDS preliminary report on 58 cases. PMID 646769
• —Zielke K, et al. Z Orthop Ihre Grenzgeb. 1982. VDS results in idiopathic lumbar scoliosis. PMID 7113372
• —Ogiela DM, et al. Spine. 1986. Early English-language review of VDS: good correction of thoracolumbar/lumbar curves. PMID 3704776
• —Hammerberg KW. Orthopedics. 1988. Zielke instrumentation technique review. PMID 3226985
• —Giehl JP, et al. Orthopade. 1989. Detailed account of Zielke VDS technique and results. PMID 2734016
• —Korovessis PG, et al. Clin Orthop Relat Res. 1992. Combined VDS + Harrington: effect on vital capacity. PMID 1395236
• —Bullmann V, et al. Spine. 2003. Dual-rod Halm-Zielke instrumentation to overcome single-rod problems. PMID 12811276
• —Halm H, et al. Acta Orthop Belg. 1995. Double-rod augmentation of Zielke VDS for thoracolumbar curves. PMID 8571763
• —Franić M, et al. Croat Med J. 2006. Historic prospective study of anterior (VDS/Zielke lineage) instrumentation for thoracic AIS. PMID 16625688