Perioperative outcome of severe rigid idiopathic scoliosis: Single-staged posterior spinal fusion utilizing a dual attending surgeon strategy. A report of 41 patients

Abstract

Purpose: Various surgical strategies including combined approach and spinal osteotomies in severe rigid scoliosis had been reported with significant perioperative complication rates. The use of single-staged posterior spinal fusion (PSF) utilizing a dual attending surgeon strategy for severe rigid scoliosis has not been widely reported. Methods: This was a retrospective study aimed to evaluate the perioperative outcome of single-staged PSF in severe rigid idiopathic scoliosis patients (Cobb angle ≥90° and ≤30% flexibility). Forty-one patients with severe rigid idiopathic scoliosis who underwent single-staged PSF were included. The perioperative outcome parameters were operation duration, intraoperative blood loss, intraoperative hemodynamic parameters, preoperative and postoperative hemoglobin, transfusion rate, patient-controlled anesthesia morphine usage, length of postoperative hospital stay, and perioperative complications. Radiological parameters included preoperative and postoperative Cobb angle, correction rate, side-bending flexibility, and side-bending correction index. Results: The mean age was 16.9 ± 5.6 years. The mean preoperative Cobb angle was 110.8 ± 12.1° with mean flexibility of 23.1 ± 6.3%. The mean operation duration was 215.5 ± 45.2 min with mean blood loss of 1752.6 ± 830.5 mL. The allogeneic blood transfusion rate was 24.4%. The mean postoperative hospital stay was 76.9 ± 26.7 h. The mean postoperative Cobb angle and correction rate were 54.4 ± 12.8° and 50.9 ± 10.1%, respectively. The readmission rate in this cohort was 2.4%. Four perioperative complications were documented (9.8%), one somatosensory evoke potential signal loss, one superficial infection, one lung collapse, and one superior mesenteric artery syndrome. Conclusions: Severe rigid idiopathic scoliosis treated with single-staged PSF utilizing a dual attending surgeon strategy demonstrated an average correction rate of 50.9%, operation duration of 215.5 min, and postoperative hospital stay of 76.9 h with a 9.8% perioperative complication rate.

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

“…A total of 1337 studies were found through electronic search; after screening, 14 studies (1 prospective cohort study,[ 23 ] 3 retrospective comparative studies,[ 24 25 26 ] 1 retrospective cohort study,[ 27 ] 6 retrospective studies,[ 28 29 30 31 32 33 ] 1 prospective CS,[ 34 ] and 2 retrospective CS[ 1 21 ]) were included. [ 1 21 23 24 25 26 27 28 30 31 33 34 ] The quality of the papers was good in 13 cases[ 1 21 23 24 25 26 27 28 30 31 33 ] and fair in 1 case. [ 34 ]…”

“…The included studies chose different criteria for the definition of severe scoliosis: Seven authors used a major curve Cobb >90° as a cutoff[ 24 27 28 30 31 32 33 ] (1 of them[ 30 ] used major curve Cobb >90° and flexibility index <30%), 4 used a major curve Cobb >80°[ 1 21 25 34 ] (2 of them[ 1 34 ] used major curve Cobb >80° and flexibility index <25%), 3 used a major curve Cobb >70°[ 23 26 35 ] [ Table 1 ].…”

“…The included studies are heterogeneous in Lenke distribution of the curves, internal fixation devices, and use of Schwab >1 osteotomies[ 36 ] [ Table 1 ]. Lenke type was reported on 549 patients: [ 1 21 34 24 23 24 25 26 27 30 31 32 33 ] 157 Lenke 1 (28.6%), 252 Lenke 2 (45.9%), 50 Lenke 3 (9.1%), 59 Lenke 4 (10.7%), 1 Lenke 5 (0.2%), and 30 Lenke 6 (5.4%). As for constructs, 11 authors used all pedicle screws constructs,[ 1 21 23 24 25 27 28 30 31 32 33 34 ] while 3 preferred hybrid constructs.…”

“…Lenke type was reported on 549 patients: [ 1 21 34 24 23 24 25 26 27 30 31 32 33 ] 157 Lenke 1 (28.6%), 252 Lenke 2 (45.9%), 50 Lenke 3 (9.1%), 59 Lenke 4 (10.7%), 1 Lenke 5 (0.2%), and 30 Lenke 6 (5.4%). As for constructs, 11 authors used all pedicle screws constructs,[ 1 21 23 24 25 27 28 30 31 32 33 34 ] while 3 preferred hybrid constructs. [ 25 26 35 ] As for osteotomies, most of the authors only performed partial facetectomies, while Mirzashahi et al .…”

“…The mean Cobb angle of the major curve varied from 80.0 ± 7.3[ 23 ] to 110.8° ± 12.1,[ 30 ] with a flexibility index range between 21.4% ± 3.8%[ 1 ] and 38.6% ± 11.8%. [ 27 ] The meta-analysis showed a comprehensive coronal correction rate of the major curve of 58.6% (95% confidence interval [CI]: 53.0–64.1, I 2 ≈ 0%, Figures 3 and 4 ).…”