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To assess possibilities of surgical treatment of patients with super severe (Cobb angle of 120 degrees and more) idiopathic scoliosis. Material and Methods. Surgical treatment was performed in 15 patients (14 females, 1 male) with idiopathic scoliosis with Cobb angle exceeding 120 degrees. Patients were followed up during 2 years and more. The mean age of patients was 16.1 years. Preoperative examination included plain and functional radiography of the spine, and traction radiography. All patients before and after operation were examined with computer optical topography and answered the SRS questionnaire. A primary method of treatment included correction of spinal deformity with segmental Cotrel-Dubousset instrumentation and posterior fusion with local bone autograft. Results. The primary curve was reduced from 129.9° to 72.5°(44.2 %). Postoperative progression was 5.9° (10.2 % of the achieved correction). Trunk imbalance was 31.2 mm before surgery, 23.2 mm just after surgery, and 15.5 mm at last follow-up. The tilt of the lowest instrumented vertebra was 26.0° before surgery, 10.7° at two weeks, and 16.7° at long-term follow-up. Thoracic kyphosis was 88.5° at initial examination, 48.1° after surgery, and 59.3° at last follow-up. The mean body height increased by 11 cm. Spirometry test showed mean respiratory volume 1357.1 ml before surgery, and 1690.0 ml at last follow-up. Conclusion. Surgical treatment of patients with super severe idiopathic scoliosis using modern instrumentation is not only possible but also necessary since it allows for radical changing in shape of the spine and the trunk, normalization of position and functions of interior organs, and improvement of patient's quality of life.

Objective. To analyse the outcomes of surgery for severe idiopathic scoliosis. Material and Methods. Seventy nine patients at the age of 12 to 20 years (male and female ratio is 8:71) with spine deformity more than 90° operated on with CDI with ventral fusion (72 patients) and without it (7 patients) were examined. Average follow-up is 1.3 years. Data of X-ray, COMOT examination, intervertebral disk morphological study and Russian version of SRS-4 questionnairy were analyzed. Results. Average correction was 55.0°. Postoperative progression was 3.4°. CDI correction with previous intervertebral disk excision at the apex of scoliotic arch added 26.5° to preoperative correction in lateral bending, and in combination with skeletal traction – 40.6°. Counter-curvature initially averaged 69.7°, correction was 36.5°, and postoperative progression – 4.0°. Preoperative thoracic kyphosis was 59.6°, postoperative – 33.8°, lumbar lordosis was decreased from 68.1° to 48.7°. Patient’s satisfaction was 100.0 % and did not decline in time. Positive dynamics was noted in all parameters of dorsal trunk shape. Conclusion. Contemporary segmental instrumentation for treatment of severe idiopathic scoliosis allows achieving and reliably retaining substantial correction of deformity. Various types of preoperative traction can be replaced by intraoperative release of the deformed spine including discectomy.

Objective. To analyze results of surgical treatment of patients with thoracic idiopathic scoliosis. Material and Methods. Fifty-two patients with Lenke type 1 idiopathic scoliosis were operated on. Follow-up periods ranged from 2 weeks to 8 years (mean 1.8 years). Surgical treatment included four types of operation: spine deformity correction with CD instrumentation; supramalleolar-andskull traction and CDI correction; discectomy and interbody fusion with bone autograft and CDI correction; supramalleolar- and-skull traction, discectomy and interbody fusion with bone autograft, and CDI correction. Patients were interrogated with pre- and postoperative SRS-24 questionnaires and examined with Computer Optical Topograph (COMOT). Results. Scoliosis was corrected from a mean of 67.7° to 26.6°, with a mean deformity value being 30.3° at the last follow- up. Thus, postoperative progression of the thoracic curve with a mean follow-up 1.8 years was 3.7° (9 % from the achieved correction). Anterior fusion provided a threefold decrease in postoperative progression. Sagittal shape of the thoracic and lumbar spine remained within norm limits. The location of the lowest instrumented vertebra (LIV) relative to a neutral vertebra, lower stable vertebra and neutralized disc did not reliably influence on the postoperative course. Postoperative deformity progression was associated only with increase in LIV tilt. SRS-24 data showed a high rate of patients’ satisfaction with the obtained effect of treatment, the rate growing with the extension of follow-up terms. Severe complications were not observed. Conclusion. Modern 3rd generation segmental instrumentation allows to obtain stable and high results of treatment for single curve thoracic idiopathic deformities, while all regularities of postoperative course are not fully understood yet.

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