Treatment of severe rigid scoliosis with one-stage posterior Ponte osteotomy and two-stage posterior orthopedics

Abstract

Objective To discuss the efficacy and safety of one-stage posterior Ponte osteotomy and two-stage posterior orthopedics in treatment of severe rigid scoliosis. Methods Retrospective review was conducted for 24 patients with severe rigid scoliosis (Cobb angle >100°) who underwent one-stage posterior Ponte osteotomy and two-stage posterior orthopedics between June 2010 and December 2012, including 9 male patients and 15 female patients. The average age is 21.4±4.1 (ranging from 14 to 30). The major curve Cobb angle on preoperative coronal plane was 106°-156° (125.8° on the average); kyphosis angle was 59°-141° (100.1° on the average). All patients experienced one-stage posterior Ponte osteotomy, screw insertion, postoperative Haloskeletal traction through supracondyle of femur and two-stage posterior orthopedic fusion. The Cobb angles of the major curve at the standing position before surgery, at supine position after posterior release and traction and on postoperative coronal plane and on coronal plane in the last follow-up. Results The flexibility of major curve at bending position before the surgery was 14.8%±7.5%; the flexibility of major curve after posterior release and traction was 29.1%±9.9%; it improves 14.3% compared with that before the surgery. The difference has statistical significance. The Cobb angle of major curve after posterior orthopedics was 74.4°±14.5° on the average; the mean correction rate was 41.0%±8.1%. It boots 26.2% and 11.9% respectively compared with preoperative bending position and posterior release and traction. The different has statistical significance. The post-operation follow-up duration was 15-36 months (24.0±5.9 months on the average). At the last follow-up, the average loss of Cobb angle of major curve was 1.4°. The post-operative kyphosis angle was 53.0°±13.7° on the average which significantly improves compared with pre-operation (100.1°±23.7°). The mean correction rate was 46.1% ±11.9%. No correction loss was shown in the last follow-up. One patient experienced superficial pin-site infection and two patients had deep venous thrombosis of the left limb. Conclusion Posterior Ponte osteotomy combined with Halo-femoral traction could achieve satisfactory correction rate for patients with severe rigid scoliosis. However, the risk caused by thrombus of lower extremity veins should be noticed during the whole procedure. Key words: Scoliosis; Osteotomy; Traction; Orthopedic procedures