Two-stage posterior correction in the treatment of severe rigid neuromuscular scoliosis: Case report

Abstract

Background: Treatment of severe rigid scoliosis is challenging. Traditional methods such as combined anterior and posterior surgery with or without perioperative halo-gravity traction, or more aggressive one-stage posterior correction methods carry many drawbacks and potential risks. To overcome this, a staged posterior approach was raised. We report a patient successfully treated with this new method. Case Report: A 15-year-old boy was diagnosed to have neuromuscular scoliosis of unknown origin. The Cobb angle was 110 degrees at T9- L4, and 77 degrees at T2- T9. The preoperative pelvic tilt was 16 degrees. Bending views showed the flexibility about 10%. Two-stage correction was performed. The major curve magnitude reduced 40 degrees or 36.3% after the first-stage surgery, and 25 degrees or 35.7% after the second-stage surgery. The final correction rate was 59.1%. The postoperative pelvic tilt reduced to 6 degrees. No complication such as infection, neurological injury or respiratory compromise was found. Discussion: This two-stage approach has many advantages, including preventing pulmonary function deterioration, no need of halo traction, avoiding too much manipulation of the spinal cord during each surgery, and facilitating curve correction. However, we should also take into consideration of its large blood loss, nutritional demand and potential risk of infection. Conclusion: Two-stage posterior correction is a reasonable and suitable alternative correction strategy in the treatment of severe rigid scoliosis. However, further study is needed to verify its validity and safety.