Posterior Spinal Fusion With Multilevel Posterolateral Convex Disc Releases for the Treatment of Severe Thoracolumbar Scoliosis.

Abstract

Severe, rigid thoracolumbar scoliosis presents a surgical challenge to achieve 3-dimensional correction, maximize distal motion segments, and avoid operative morbidity conferred by combined anterior-posterior approaches or 3-column osteotomies. We present a new approach for releasing these curves, using multilevel posterolateral convex disc release (PCDR) and posterior instrumented fusion. There were 3 adults and 1 adolescent (mean age, 31.8 years; 2 females) with severe progressive thoracic and transforaminal lumbar (major) idiopathic scoliosis (IS) who were treated with 3-level PCDR, multiple posterior column osteotomies, and posterior instrumented thoracolumbar fusion with all-pedicle screw constructs. Restoration of global coronal and sagittal alignment was achieved for all patients (minimum 2-year follow-up). Lowest instrumented vertebra (LIV) was L4 in 2 patients and L3 in the remaining 2. All except 1 were fused to the lower end vertebra. Postoperatively, mean thoracolumbar curve was reduced from 77.3° (range, 69°-91°) to 21.8° (72%Δ), LIV tilt decreased from 26.8° to 8.3°, and LIV translation improved (2.5-1.2 cm; 58%Δ), whereas lumbar lordosis remained unchanged. Average central sacral vertical line shift measured via C7 sagittal vertical axis changed from 1.4 to -0.7 cm. There were no complications except for dysesthesias in the lower extremity on the side of the PCDR in 1 patient, which resolved after 3 months. Severe thoracolumbar IS presents a surgical challenge to achieve 3-dimensional correction, minimize fusion levels, and avoid procedural morbidity. PCDR is a novel technique that may facilitate this correction with minimal procedure-related morbidity.