Staged surgical treatment for severe rigid scoliosis
STUDY DESIGN: A retrospective study of staged surgery for severe rigid scoliosis. OBJECTIVES: To evaluate the result of staged surgery in treatment of severe rigid scoliosis and to discuss the indications.
SUMMARY OF DATA: Excellent outcomes of hemivertebra excision, vertebral body resection, and spinal osteotomy have been reported for angular kyphosis or kyphoscoliosis. However, their safety and effectiveness of these procedures have not been estimated.
It would be difficult to correct severe and rigid spinal deformities satisfactorily by a single procedure in consideration of the neurological safety. In consequence, staged surgeries have been widely used in the treatment of severe rigid scoliosis.
Nevertheless, in few papers the method of anterior releases followed by halo-pelvic traction has been mentioned.MethodS: From 1998 to 2006, 21 cases of severe rigid scoliosis with coronal Cobb angle more than 80Adegrees 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 15.3yearsirang from 4 to 23 yearsiiThe mean pre-operative Cobb angle was 110.5Adegrees(80Adegrees-145Adegrees) with a mean spine flexibility of 13%. Radiological parameters at different operative time points were analyzed ( mean time of follow-up: 51 months)
Results: : External 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 2.23Adegrees at the end of follow-up. No decompensation of trunk have been found.
Mean distance between the midline of C7 and midsacral line was 1.19 cm A+/-0.51. Two patients had neurological complications: one patient had motor deficit and recovered incompletely.
Conclusions: : Staged operation and halo-pelvic traction offer a safe and effective way in treatment of severe rigid scoliosis.
Patients whose Cobb angle was more than 80Adegrees 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 70Adegrees after 1st stage anterior release and halo-pelvic traction should undergo pedicle subtraction osteotomy (PSO) in the second surgery.Key words: scoliosis, severe, two stages, pedicle subtraction osteotomy (PSO)
Author: Shi Yamin, Li Li, Wei Xing, Gao Tianjun and Zhang Yupeng
Credits/Source: Journal of Orthopaedic Surgery and Research 2008, 3:26
Published on: 2008-07-09
Copyright by the authors listed above - made available via BioMedCentral (Open Access). Please
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