Effects of wide posterior release on the correction of severe and rigid thoracic scoliosis in sagittal plane

Abstract

To explore the effects of wide posterior release on the correction of severe and rigid thoracic scoliosis in sagittal plane. A total of 37 idiopathic scoliosis patients (26 females and 11 males) with severe and rigid thoracic curves corrected with posterior pedicle screw system between 2006 and 2009 were recruited. Their average age was 17.3 years (range: 14 - 22) at operation and the thoracic Cobb angle was between 70 - 100°. They were separated into 2 groups: group A (n = 15) with wide posterior release and group B (n = 22) with posterior soft tissue release alone. The preoperative, postoperative and latest standing posteroanterior and lateral radiographs during follow-ups were reviewed. All patients were operated successfully. No statistic difference existed in the average operative duration between two groups (P > 0.05). The average volume of blood loss was 874 ml in Group A versus 712 ml in Group B (P < 0.05). The average coronal Cobb angle on postoperative standing photograph was 27.4° (68.1% correction) in Group A and 35.6° (56.9% correction) in Group B. For comparing sagittal correction results in patients with similar thoracic sagittal deformities, we distinguished subgroup A1 (preoperative TKA < 40°) from subgroup A2 (preoperative TKA > 40°) in group A and subgroup B1 (preoperative TKA < 40°) from subgroup B2 (preoperative TKA > 40°) in group B. The postoperative TKA was 26.8° (> 9.2° than preoperation) in subgroup A1 and 12.5° (3.1° < preoperation) in subgroup B1 (P < 0.05). The postoperative TKA was 28.4° (24.9° < preoperation) in subgroup A2 and 39.1° (10.3° < preoperation) in subgroup B2 (P < 0.05). There was one case of dural leakage in group A. A leakage of cerebrospinal fluid was cured with a prone position and wound compression. One case of infection in superficial part of wound in group B was cured after debridement. No nerve system injury, deep infection or instrumentation failure was found. During a follow-up period of 2 years, there was no obvious correction loss or trunk decompensation. In idiopathic scoliosis patients with severe and rigid thoracic curves, wide posterior release via a posterior approach may help to correct the deformity in sagittal plan and achieve more coronal correction in these curves.