Treatment Of Severe Rigid Scoliosis Research Articles

Severe-Rigid Scoliosis Treated by Two-Staged Procedures: A Case Series

In developing countries, a large proportion of patients with scoliosis present late, especially the underprivilege, so the curves had become rigid and severe. There is still no consensus about the surgical management of the severe and rigid scoliosis and some literatures suggested that combined anterior and posterior or single-stage posterior-only instrumentation are generally required for the correction of these deformities. We presented three cases of severe rigid scoliosis treated surgically in our center with two staged operation (anterior surgery and posterior instrumentation). A retrospective review was undertaken of patients with severe scoliosis who had undergone two-staged operation in Orthopaedics and Traumatology Department of Prof Ngoerah General Hospital Bali during the period between January 2018 and February 2020. The data was obtained from the hospital’s medical records and archives in our department, included sex, age, the severity and reducibility of the Cobb angle, maturity rate, treatment, length of stay, complications found, and the Scoliosis Research Society: 30 Questionnaire (SRS-30) score before and three months after the surgery. During the period of between January 2018 and February 2020, there were three cases of severe rigid scoliosis who underwent two-staged operation. The two staged operation performed were anterior surgery (soft tissue release, corpectomy, and anterior fusion), and posterior instrumentation (facetetectomy, rotation, stabilization, and fusion). There were one case of intra-operative hypovolemic shock and anemia that could be corrected succesfully. All three patients showed no complaint and the clinical examination showed improvements of the deformity post operatively. There were also improvement of the total SRS-30 score of all three patients after the two staged procedures performed (mean = 4.4) compared to pre-operative score (mean = 3.4). The two-staged operation including anterior surgery and posterior instrumentation is still a safe and effective way in treatment of severe rigid scoliosis.

Outcome of Posterior-Only Approach for Severe Rigid Scoliosis: A Retrospective Report.

The management of severe scoliosis may lead to significant complications, and adequate mobilization is a key step to achieve maximal correction, usually requiring extensive approaches. There is still no consensus on the management of these severe and rigid curves. In this study we evaluated the clinical and radiologic outcome of a posterior-only approach with multilevel asymmetric Ponte osteotomy with a minimum of 2 years' follow-up. In this retrospective study, 23 patients with severe and rigid adolescent idiopathic scoliosis who underwent surgery with a single-staged posterior-only approach were included. The surgical procedures in these patients were excision of posterior ligaments and spinous process, partial laminectomy in caudal part of lamina, excision of the ligamentum flavum, facetectomies, and multilevel asymmetric posterior column osteotomies (Ponte) followed by instrumented fusion. Clinical records-including demographic data; operating time; hospitalization time; blood loss; number of segments instrumented, fused, and osteotomized; functional improvement; follow-up duration; and complications-were recorded. The mean preoperative Cobb angle of major curve in coronal plan was 97.5° (range, 82°-131°) with the mean flexibility of 21.4° (range, 10°-25°) on bending radiography. The mean immediate postoperative Cobb angle of major curve was 34.8° (range, 17°-61°), showing a 64.2% correction. The mean preoperative coronal and sagittal imbalances of 3.8 and 4.2 cm were improved to 1.0 and 1.3 cm at postoperative measurements, respectively. A mean of 6.1 (range, 5-9) vertebral segments were osteotomized. We experienced no major complications. We found that a posterior-only procedure in patients with severe and rigid adolescent idiopathic scoliosis could provide correction rate, coronal and sagittal balance, and clinical outcomes comparable with other procedures. Using this technique can eliminate the need for the anterior release, with the associated complications related to anterior surgery, in the treatment of severe rigid scoliosis.

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

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.

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

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

Anterior or Posterior Release for Severe Rigid Scoliosis: Which is Safer and More Effective?

Introduction Various correction methods have been developed to treat severe rigid scoliosis. The anterior release was performed for many years to improve the flexibility of rigid scoliosis, however, the safety and efficacy of combined anterior/posterior approach were questioned by many authors. This study aimed to evaluate the efficacy and safety of two-stage posterior surgery for severe rigid scoliosis and to determine whether posterior release is safer and more effective than anterior release. Patients and Methods A total of 27 patients undergoing the staged posterior procedure were included in P–P group and 32 patients undergoing staged anterior/posterior procedure were included in A–P group. Halo-femoral traction was used after the release procedure for both the groups. The flexibility and correction rate were evaluated to quantify the contribution of spinal release and traction to curve flexibility. Radiographic outcomes were compared between the two groups before surgery, after release and traction, immediately postoperatively, and at the last follow-up. Results Gender, release and fusion segments, duration and weight of traction, main curve magnitude, and curve type were similar between the two groups. Significant lower flexibility of main curve ( p = 0.001) and higher global kyphosis ( p < 0.001) was found in P–P group. For patients in the P–P group, the flexibility of major curve averaged 14.1% before surgery, which increased to 32.5% after posterior release and Halo-femoral traction ( p < 0.001) and showed 44.9% correction postoperatively. Compared with patients in A–P group, patients in the P–P group seemed more benefited from release and Halo-femoral traction (18.4 vs.12.9%, p = 0.021) although they had significantly more rigid scoliosis before surgery (14.1 vs. 21.0%, p < 0.001). Besides, the final correction rate of the main curve was similar between the two groups (50.1 vs. 44.9%, p = 0.094). Five patients in the A–P group were found to have respiratory system related complications, whereas only one patient in P–P group experienced superficial pin site infection combined with deep venous thrombosis of the left limb. Conclusion Staged posterior surgery provides a safe and effective option for the treatment of severe rigid scoliosis. And posterior release seems superior for anterior release regarding the surgical outcomes.

Posterior Extrapleural Intervertebral Space Release Combined With Wedge Osteotomy for the Treatment of Severe Rigid Scoliosis

Retrospective clinical case series. To report the technique and results of posterior extrapleural intervertebral space release (PEISR) combined with wedge osteotomy (WO) for the treatment of severe rigid scoliosis. Conventional surgical correction techniques for severe rigid scoliosis include anterior release combined with posterior instrumentation and fusion and vertebral column resection. Between 2004 and 2009, 18 patients underwent PEISR and WO at a single institution. The indications were scoliosis with coronal Cobb's angle greater than 90° and curve flexibility less than 25%. The median age at surgery was 18.1 years (range, 13-26 yr). Nine patients had a preoperative forced vital capacity that was less than 40% of predicted. All patients had a minimum 2-year radiographical and clinical follow-up (range, 2.0-5.7 yr). A mean of 4.2 discs were excised per patient (range, 2-6 discs) along with a mean of 1.2 vertebrae removed in the osteotomy. Mean number of vertebrae fused was 13.8 (range, 10-16 vertebrae). Mean operating time was 8.8 hours (range, 6.2-12.6 hr), with a mean blood loss of 3990 mL (range, 2600-6100 mL). The mean preoperative Cobb angle of 108.5° (range, 92°-136°) was corrected to 30° at the most recent follow-up (72.4% correction rate). Preoperative thoracic kyphosis of 52° (range, 5°-115°) was corrected to 26° (range, 17°-52°). The mean preoperative coronal imbalance of 3.5 cm was corrected to 0.6 cm (83.8% correction) and the sagittal imbalance of 2.8 cm was corrected to 0.3 cm (90.3% correction). There were no neurological complications. There were no instances of infection or muscle necrosis. Hemopneumothorax occurred in 2 patients. PEISR, combined with WO, through a single posterior approach is a technically challenging but safe and effective procedure for severe rigid scoliosis. This posterior-only approach allows for dramatic radiographical correction that surpasses that reported for posterior VCR.

Staged surgical treatment for severe and rigid scoliosis

BackgroundA retrospective study of staged surgery for severe rigid scoliosis. The purpose of this study was to evaluate the result of staged surgery in treatment of severe rigid scoliosis and to discuss the indications.MethodsFrom 1998 to 2006, 21 cases of severe rigid scoliosis with coronal Cobb angle more than 80° were treated by staged surgeries including anterior release and halo-pelvic traction as first stage surgery and posterior instrumentation and spinal fusion as second stage. Pedicle subtraction osteotomy(PSO) was added in second stage according to spine rigidity. Among the 21 patients, 8 were male and 13 female with an average age of 15.3 years (rang from 4 to 23 years). The mean pre-operative Cobb angle was 110.5° (80°-145°) with a mean spine flexibility of 13%. Radiological parameters at different operative time points were analyzed (mean time of follow-up: 51 months).ResultsExternal appearance of all patients improved significantly. The average correction rate was 65.2% (ranging from 39.8% to 79.5%) with mean correction loss of 2.23° at the end of follow-up. No decompensation of trunk has been found. Mean distance between the midline of C7 and midsacral line was 1.19 cm ± 0.51. Two patients had neurological complications: one patient had motor deficit and recovered incompletely.ConclusionStaged operation and halo-pelvic traction offer a safe and effective way in treatment of severe rigid scoliosis. Patients whose Cobb angle was more than 80° and the flexibility of the spine was less than 20% should be treated in this way, and those whose flexibility of the spine was less than 10% and the Cobb angle remained more than 70° after 1st stage anterior release and halo-pelvic traction should undergo pedicle subtraction osteotomy (PSO) in the second surgery.

Posterior Vertebral Column Resection for Severe Rigid Scoliosis

Retrospective study. To report on the technique and results of posterior vertebral column resection (PVCR) for severe rigid scoliosis. The treatment of severe rigid scoliosis is a demanding surgical challenge. Conventional procedures such as combined anteroposterior instrumentation enable limited correction. In rigid scoliosis, vertebral column resection is a better option for accomplishing translation of spinal column. PVCR is performed through a single posterior approach. A total of 16 patients with scoliosis (average age 29 years) subjected to PVCR were retrospectively reviewed after a minimum follow-up of 2 years (range 2-6.8). The indication for PVCR was scoliosis more than 80 degrees , with flexibility less than 25%. The radiographic parameters were evaluated, and clinical records were reviewed. The number of vertebrae removed averaged 1.3, and 21 total (15 thoracic and 6 lumbar). Average fusion extent was 10.6 vertebrae. The mean preoperative scoliosis of 109.0 degrees was corrected to 45.6 degrees (59% correction) at the most recent follow-up, and the minor curve of 59.3 degrees was corrected to 29.2 degrees (51% correction). The mean preoperative coronal imbalance of 4.0 cm was improved to 1.0 cm at the most recent follow-up, and sagittal imbalance of 4.2 cm was improved to 1.6 cm. Complications were encountered in 4 patients, including 1 complete paralysis, 1 hematoma, 1 hemopneumothorax, and 1 proximal junctional kyphosis. PVCR is an effective alternative for severe rigid scoliosis. It is a highly technical procedure and should only be performed by an experienced surgical team.