Management of severe and rigid idiopathic scoliosis

Abstract

Frequently, severe idiopathic scoliosis patients are first seen in a spine centre after years of deformity evolution, presenting with large curves, severe rib hump, shoulder and trunk imbalance and cardiorespiratory complications related to neglected scoliosis. Severe rigid idiopathic scoliosis has <25 % of correction on bending films and major curve over 90°. Adequate mobilization of this type of deformity is necessary to achieve maximal correction, often requiring more extensive surgical intervention, with care taken to avoid clinical and neurological complications. Halo traction, internal temporary distraction, releases, osteotomies and apical vertebral resection are often used in combination to achieve optimal results. Indications must be tailored by surgeons considering resources, deformity characteristics and patient’s profile. Vertebral resection procedures may have potential neurological and clinical risks and should be one of the last treatment options performed by experienced surgical team. Neuromonitoring is essential during these procedures.

Severe Rigid Scoliosis: Review of Management Strategies and Role of Spinal Osteotomies

“…Other procedures including the use of halo traction preoperatively, peroperatively, or halo traction after release (anterior or posterior) have been reported and favored by many surgeons [ 8 17 18 19 20 21 ]. Similarly, anterior release with apical derotation and anterior fixation followed by posterior correction and instrumentation (staged) have been reported too, with good results [ 16 ].…”

“…Severe and rigid scoliosis has been a subject of review and interest for multiple authors [ 2 5 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 ]. Sucato [ 3 ] reports that severe spinal deformity should be distinguished from the more common adolescent idiopathic scoliosis deformity in that both the spine and the chest wall are affected.…”

Preoperative Halo-Gravity Traction for Severe Thoracic Kyphoscoliosis Patients from Tibet: Radiographic Correction, Pulmonary Function Improvement, Nursing, and Complications

“…The most common cause of neurological injury was excessive traction or traction applied too rapidly. Tindall et al [ 30 ] reported traction-related complications as high as 53%, with 31% suffering from transient HGT-related neurologic compromise. Wilkins et al [ 31 ] reported the cranial nerve complication rate was 8.6% in 70 patients with skeletal traction.…”

Clinical and Radiological Outcomes of Less Invasive Temporary Internal Distraction Followed by Staged Pedicle Screw Instrumentation in Adolescents with Severe Idiopathic Scoliosis at 2-Year Minimum Follow-Up

“…Treatment of severe spinal deformities (SSD) is complicated because they may cause compression of the spinal cord and thoracoabdominal structures [1,2], which may lead to neurological and cardiopulmonary anomalies, thus affecting patient's daily activities, growth, development, and physical appearance [3,4]. Radical correction of large and stiff curvatures increases the risk of neurological complications.…”

“…Other options, such as internal distraction, releases, osteotomies, and apical vertebral resection are often used in combination to achieve optimal results [4][5][6].…”