Staged surgical treatment for severe and rigid scoliosis

Abstract

BackgroundA retrospective study of staged surgery for severe rigid scoliosis. The purpose of this study was to evaluate the result of staged surgery in treatment of severe rigid scoliosis and to discuss the indications.MethodsFrom 1998 to 2006, 21 cases of severe rigid scoliosis with coronal Cobb angle more than 80° were treated by staged surgeries including anterior release and halo-pelvic traction as first stage surgery and posterior instrumentation and spinal fusion as second stage. Pedicle subtraction osteotomy(PSO) was added in second stage according to spine rigidity. Among the 21 patients, 8 were male and 13 female with an average age of 15.3 years (rang from 4 to 23 years). The mean pre-operative Cobb angle was 110.5° (80°-145°) with a mean spine flexibility of 13%. Radiological parameters at different operative time points were analyzed (mean time of follow-up: 51 months).ResultsExternal appearance of all patients improved significantly. The average correction rate was 65.2% (ranging from 39.8% to 79.5%) with mean correction loss of 2.23° at the end of follow-up. No decompensation of trunk has been found. Mean distance between the midline of C7 and midsacral line was 1.19 cm ± 0.51. Two patients had neurological complications: one patient had motor deficit and recovered incompletely.ConclusionStaged operation and halo-pelvic traction offer a safe and effective way in treatment of severe rigid scoliosis. Patients whose Cobb angle was more than 80° and the flexibility of the spine was less than 20% should be treated in this way, and those whose flexibility of the spine was less than 10% and the Cobb angle remained more than 70° after 1st stage anterior release and halo-pelvic traction should undergo pedicle subtraction osteotomy (PSO) in the second surgery.

The impact of halo-gravity traction on curve rigidity and pulmonary function in the treatment of severe and rigid scoliosis and kyphoscoliosis: a clinical study and narrative review of the literature

“…With VCR, temporary neurologic deficits have been seen in up to 30% of patients [5,8,11,14,15,56,57,60,65]. It must be emphasised that in our study, there was no permanent neurologic decline.…”

“…A mean scoliosis of 93°with a flexibility of 23% was corrected by 67%. In another study [15] on 21 patients with a mean scoliosis of 111°and a flexibility of 13%, a 62% correction was achieved after the application of a halofemoral traction Ilizarov-type device following an anterior release. In summary, there are alternatives to VCR for severe and rigid but rather harmonic curves, and a multilevel segmental release and instrumentation might be sufficient to maximise correction and improve pulmonary function.…”

“…The problems arise with the lack of uniform definitions of severe and rigid curves [1,9,13,15,19,50,56,58,62]. Generally, severe curves have a Cobb angle [80°-90°, are rigid when the flexibility is \20-30% and bend down to 70°-80°at best.…”

“…Because of the growing number of reports using modern pedicle screw systems in combination with aggressive releases for the correction of severe curves [8,9,11,[14][15][16][17][18][19][20][21], the authors scrutinised the value of HGT within treatment modalities applied in the past decade by analysing a sample of patients with severe, rigid (kypho-)scoliosis. We sought to quantify the impacts of preoperative HGT on pulmonary function and curve correction to more precisely define the indications for HGT.…”

High Density Pedicle Screws through Posterior Only Approach for Surgical Correction of Severe Adolescent Idiopathic Scoliosis > 70o

“…8 The combined anterior and posterior procedure can be performed in one or two stage surgery with or without halo traction in-between. 2,26 Additional anterior surgery requires increased time for the general anesthesia and may have a negative impact on pulmonary function, longer hospital stay, more blood loss and longer operative time. 5 Video assisted thoracoscopic surgery (VATS), used for the anterior release, followed by posterior instrumentation have been also used for severe rigid AIS.…”