Anterior or Posterior Release for Severe Rigid Scoliosis: Which is Safer and More Effective?

Abstract

Introduction Various correction methods have been developed to treat severe rigid scoliosis. The anterior release was performed for many years to improve the flexibility of rigid scoliosis, however, the safety and efficacy of combined anterior/posterior approach were questioned by many authors. This study aimed to evaluate the efficacy and safety of two-stage posterior surgery for severe rigid scoliosis and to determine whether posterior release is safer and more effective than anterior release. Patients and Methods A total of 27 patients undergoing the staged posterior procedure were included in P–P group and 32 patients undergoing staged anterior/posterior procedure were included in A–P group. Halo-femoral traction was used after the release procedure for both the groups. The flexibility and correction rate were evaluated to quantify the contribution of spinal release and traction to curve flexibility. Radiographic outcomes were compared between the two groups before surgery, after release and traction, immediately postoperatively, and at the last follow-up. Results Gender, release and fusion segments, duration and weight of traction, main curve magnitude, and curve type were similar between the two groups. Significant lower flexibility of main curve ( p = 0.001) and higher global kyphosis ( p < 0.001) was found in P–P group. For patients in the P–P group, the flexibility of major curve averaged 14.1% before surgery, which increased to 32.5% after posterior release and Halo-femoral traction ( p < 0.001) and showed 44.9% correction postoperatively. Compared with patients in A–P group, patients in the P–P group seemed more benefited from release and Halo-femoral traction (18.4 vs.12.9%, p = 0.021) although they had significantly more rigid scoliosis before surgery (14.1 vs. 21.0%, p < 0.001). Besides, the final correction rate of the main curve was similar between the two groups (50.1 vs. 44.9%, p = 0.094). Five patients in the A–P group were found to have respiratory system related complications, whereas only one patient in P–P group experienced superficial pin site infection combined with deep venous thrombosis of the left limb. Conclusion Staged posterior surgery provides a safe and effective option for the treatment of severe rigid scoliosis. And posterior release seems superior for anterior release regarding the surgical outcomes.