Outcome of Posterior-Only Approach for Severe Rigid Scoliosis: A Retrospective Report

Abstract

Background: The management of severe scoliosis may lead to significant complications, and adequate mobilization is a key step to achieve maximal correction, usually requiring extensive approaches. There is still no consensus on the management of these severe and rigid curves. In this study we evaluated the clinical and radiologic outcome of a posterior-only approach with multilevel asymmetric Ponte osteotomy with a minimum of 2 years' followup.Methods: In this retrospective study, 23 patients with severe and rigid adolescent idiopathic scoliosis who underwent surgery with a single-staged posterior-only approach were included. The surgical procedures in these patients were excision of posterior ligaments and spinous process, partial laminectomy in caudal part of lamina, excision of the ligamentum flavum, facetectomies, and multilevel asymmetric posterior column osteotomies (Ponte) followed by instrumented fusion. Clinical records-including demographic data; operating time; hospitalization time; blood loss; number of segments instrumented, fused, and osteotomized; functional improvement; follow-up duration; and complications-were recorded.Results: The mean preoperative Cobb angle of major curve in coronal plan was 97.58 (range, 828-1318) with the mean flexibility of 21.48 (range, 108-258) on bending radiography. The mean immediate postoperative Cobb angle of major curve was 34.88 (range, 178-618), showing a 64.2% correction. The mean preoperative coronal and sagittal imbalances of 3.8 and 4.2 cm were improved to 1.0 and 1.3 cm at postoperative measurements, respectively. A mean of 6.1 (range, 5-9) vertebral segments were osteotomized. We experienced no major complications.Conclusions: We found that a posterior-only procedure in patients with severe and rigid adolescent idiopathic scoliosis could provide correction rate, coronal and sagittal balance, and clinical outcomes comparable with other procedures. Using this technique can eliminate the need for the anterior release, with the associated complications related to anterior surgery, in the treatment of severe rigid scoliosis.

Sequential correction using satellite rod for the treatment of severe rigid spinal deformity: a retrospective study of 19 cases

“…To date, there have been many surgical approaches to treat severe spinal deformities, including preoperative traction followed by posterior instrumentation, combined anterior and posterior procedure, PSO or VCR by posterior procedure [ 7 , 10 , 20 ]. PVCR has been widely reported to treat severe rigid spinal deformity.…”

“…It is essential to develop detailed surgical plans based on the curve's location, magnitude, and stiffness prior to surgery. More and more evidences have shown that posterior-only osteotomy and instrumented fusion have excellent surgical outcomes in recent years [ 6 – 10 ]. The posterior vertebral column resection (PVR) involves removing one or more vertebrae to improve trunk balance and curvature correction.…”

Plasma proteomics analysis of adolescent idiopathic scoliosis patients revealed by Quadrupole‐Orbitrap mass spectrometry

“…All patients in surgery group underwent a single‐staged posterior‐only approach surgery with pedicle screws and titanium alloy 2‐rod system according to the guidelines described by Lenke [17]. During surgery, multilevel Ponte osteotomy was performed if there existed severe and rigid curves [18].…”

Surgical treatment of severe adolescent idiopathic scoliosis through one-stage posterior-only approach

“…In fact, the management of scoliotic patients with severe curves may lead to significant complications related to extended exposure and blood loss, cord injury, and pulmonary compromise. [ 1 ] The goal of operative treatment is to obtain an acceptable correction of the deformity, to improve the patient's quality of life and cardiopulmonary status, and to prevent painful degeneration and curve progression. [ 2 ]…”