Surgical treatment of severe congenital scoliosis with unilateral unsegmented bar by concave costovertebral joint release and both-ends wedge osteotomy via posterior approach

Abstract

Congenital scoliosis with unilateral unsegmented bar has remained a surgical challenge. If it is treated with a traditional release of the convex side and an apical wedge osteotomy, there is a risk of bony bridge fracture on the concave side and spine translation during correction maneuvers, which may then result in spinal cord injuries. The authors developed a technique that consists of a concave-side costovertebral joint release followed by both-ends wedge osteotomy via a posterior-only approach. In this article, we describe the technique in detail, and present the results of ten patients treated with this technique. A total of ten patients with congenital scoliosis with unilateral unsegmented bar, who had undergone a concave-side costovertebral joint release followed by both-end wedge osteotomy via a posterior-only approach were followed up for a mean of 34months (range 26-48months). The radiographic parameters and clinical records were all reviewed and analyzed. Body height increased by a mean of 7.3cm (range 6.0-9.0cm). The preoperative coronal Cobb angle was 102° (range 83°-139°) with a mean flexibility of 14%. At the most recent follow-up visit, the mean Cobb angle was 35° (range 12°-53°) and the mean correction rate was 66%. The coronal imbalance improved from 3.4cm (range 0.8-6.3cm) preoperatively to 1.1cm (range 0.6-1.8cm) postoperatively, a 67% correction. There were no definite pseudarthroses, no implant failure, and no obvious loss of correction in the follow-up period. Complications included one patient with hemopneumothorax and another patient with incomplete paralysis of the left lower extremity caused by a pedicle screw violating the spinal canal at the T5 level. The screw was removed 4h after the initial operation, and the patient fully recovered after 3months. We have had good results with our technique of concave-side costovertebral joint release and both-end wedge osteotomy. It has the advantage of remnant anulus fibrosus, the ligamentum flavum, and the facet joints on the concave side serving both as a hinge and to minimize translation of the spine ends. It can provide excellent three-dimensional curve correction for patients with severe rigid congenital scoliosis with unilateral unsegmented bar.