Abstract
PurposeWe previously reported anterior release, posterior internal distraction, and subsequent spinal fusion (ARPIDF) for the correction of severe scoliosis with a satisfactory correction rate. However, surgical procedures were completed in 2–3 stages. Here we compare Cobb angle of ≥90° in scoliosis correction between a novel posterior multiple screws distraction reducer (MSDR) system and ARPIDF.MethodsThirty-six patients with severe scoliosis treated by MSDR or ARPIDF (n = 18 in both groups). We retrospectively analyzed and compared outcome measures between the two groups over a minimum follow-up duration of 2 years. The following variables were compared between the two groups: age at surgery, sex, etiology, flexibility of the main thoracic curve, number of fused segments and screws, operation time, estimated blood loss, hospitalization time, follow-up duration, various radiological parameters, complication rate, and Scoliosis Research Society-30 score.ResultsThere were no significant between-group differences with respect to age, sex, etiology, flexibility of the main thoracic curve, number of fused segments and screws, and follow-up duration. Further, there was no significant difference in terms of preoperative, postoperative, and final follow-up findings of the radiographic data. However, the ARPIDF group had longer operation and hospitalization times and greater blood loss. In the ARPIDF group, 4 patient developed complications (infection, intraoperative neuromonitoring changes, transient dyspnea); none of these events occurred in the MSDR group.ConclusionThe use of MSDR helped achieve greater scoliosis correction with a shorter operation time, lower blood loss, and lower complication rate than the use of ARPIDF. MSDR facilitates safer and easier correction of severe scoliosis without increasing surgical risk.
Highlights
The surgical treatment of severe scoliosis is technically challenging and potentially risky [1,2,3]. Various correction methods, such as posterior instrumentation combined with anterior release [4,5,6], combined anterior and posterior surgical procedures with halo traction [7, 8], vertebral column decancellation [9], and combined anterior and posterior instrumentation [10], have been reported to date
Provisional rods are placed on the concave side of the spine proximally and distally; these rods are linked to an external distraction reduction device termed multiple screws distraction reducer system (MSDR)
In the ARPIDF group (n = 18), scoliosis was corrected using anterior release with temporary posterior internal distraction followed by posterior spinal fusion and instrumentation
Summary
The surgical treatment of severe scoliosis is technically challenging and potentially risky [1,2,3] Various correction methods, such as posterior instrumentation combined with anterior release [4,5,6], combined anterior and posterior surgical procedures with halo traction [7, 8], vertebral column decancellation [9], and combined anterior and posterior instrumentation [10], have been reported to date. We developed a novel device to achieve scoliosis correction in a safe and more effective manner. The purpose of the current study was to introduce this novel device and compare MSDR with ARPIDF for severe scoliosis (Cobb angle ≥90°) with respect to radiographic outcomes, operation time, intraoperative blood loss, complication rate, and Scoliosis Research Society (SRS)-30 scores
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