Analysis of the results of surgical treatment in idiopathic thoracic scoliosis with Cobb angle 80º-100º
Keywords:idiopathic scoliosis, anterior spinal mobilization, posterior corrective fusion, spinal osteotomies
Anterior spinal mobilization is an effective method of staged correction of thoracic idiopathic scoliosis with a Cobb angle of 80-100º. The introduction of modern transpedicular implants and osteotomies of the posterior support complex into clinical practice has reduced the frequency of its use, but increased the number of neurological complications.
Purpose - to compare the results of anterior mobilization in combination with posterior corrective fusion and posterior corrective fusion alone in patients with stiff thoracic idiopathic scoliosis.
Materials and methods. A retrospective comparative analysis of the results of surgical treatment of 167 patients with thoracic idiopathic scoliosis with a Cobb angle of 80-100º was performed. Patients were divided into two groups: the Group 1 - 83 patients (mean age - 13.7 years) who underwent anterior curvature mobilization and posterior corrective fusion, the Group 2 - 84 patients (mean age - 14.7 years) who underwent posterior corrective fusion and Ponte osteotomy at 3-5 levels.
Results. The average thoracic Cobb angle before surgery in the Group 1 was 87.1º (±1.96), in the Group 2 - 83.8º (±2.85); after surgery - 32.2º (±2.24), or 63% correction, and 44.2º (±3.22), or 47% correction, respectively. The total average duration of surgical interventions in the Group 1 was 410 minutes (140 minutes + 270 minutes), in the Group 2 - 320 minutes. Intraoperative blood loss was 890 ml and 900 ml, respectively. The average volume of haemotransfusion was 650 ml and 672 ml, respectively. The average hospital stay was 15.6 days and 8.6 days, respectively.
Conclusions. Compared with posterior corrective fusion, the use of two-stage treatment, which includes anterior mobilization of the curvature and posterior corrective fusion for surgical correction of stiff scoliotic spinal deformities, allows to increase the intraoperative correction of the main curvature by 17%.
The study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee of all the institutions mentioned in the study. Informed consent was obtained from the patients.
No conflict of interests was declared by the authors.
Bernstein RM, Hall JE. (1998). Solid rod short segment anterior fusion in thoracolumbar scoliosis. J Pediatr Orthop B. 7 (2): 124-131. https://doi.org/10.1097/01202412-199804000-00006; PMid:9597587
Betz RR, Harms J, Clements DH, Lenke LG, Lowe TG, Shufflebarger HL et al. (1999). Comparison of anterior and posterior instrumentation for correction of adolescent thoracic idiopathic scoliosis. Spine (Phila Pa 1976). 24 (3): 225-239. https://doi.org/10.1097/00007632-199902010-00007; PMid:10025017
Bridwell KH, Lewis SJ, Rinella A, Lenke LG, Baldus C, Blanke K. (2004). Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance: surgical technique. J Bone Joint Surg Am. 86A (1): 44-50. https://doi.org/10.2106/00004623-200403001-00007; PMid:14996921
Buckland AJ, Moon JY, Betz RR, Lonner BS, Newton PO et al. (2019, Feb 1). Ponte Osteotomies Increase the Risk of Neuromonitoring Alerts in Adolescent Idiopathic Scoliosis Correction Surgery. Spine. 44 (3): E175-E180. https://doi.org/10.1097/BRS.0000000000002784; PMid:30005041
Burton DC, Sama AA, Asher MA, Burke SW, Boachie- Adjei O, Huang RC et al. (2005). The treatment of large (.70 8) thoracic idiopathic scoliosis curves with posterior instrumenta- tion and arthrodesis: when is anterior release indicated? Spine. 30 (17): 1979-1984. https://doi.org/10.1097/01.brs.0000176196.94565.d6; PMid:16135989
Di Silvestre M, Bakaloudis G, Lolli F, Vommaro F, Martikos K, Parisini P. (2008). Posterior fusion only for thoracic adolescent idiopathic scoliosis of more than 80 degrees: pedicle screws versus hybrid instrumentation. Eur Spine J. 17 (10): 1336-1349. https://doi.org/10.1007/s00586-008-0731-9; PMid:18696126 PMCid:PMC2556476
Dobbs MB, Lenke LG, Kim YJ, Luhmann SJ, Bridwell KH. (2006). Anterior/posterior spinal instrumentation versus posterior instrumentation alone for the treatment of adolescent idiopath- ic scoliotic curves more than 90 degrees. Spine (Phila Pa 1976). 31 (20): 2386-2391. https://doi.org/10.1097/01.brs.0000238965.81013.c5; PMid:16985469
Lenke LG, Newton PO, Sucato DJ, Schuflleburger HL. (2013, Jan 15). Complications after 147 consecutive vertebral column resections for severe pediatric spinal deformity: a multicenter analysis. Spine (Phila Pa 1976). 38 (2): 119-132. https://doi.org/10.1097/BRS.0b013e318269fab1; PMid:22825478
Levytskyi AF, Rogozinskyi VA, Dolianytskyi MM. (2020). Halo-gravity traction in the treatment of complex (>100°) scoliotic deformities of the spine in children: a review of clinical cases. Paediatric Surgery. Ukraine. 4 (69): 67-71. https://doi.org/10.15574/PS.2020.69.67
Lewis SJ, Wong IHY, Strantzas S, Holmes LM. (2019, May). Responding to Intraoperative Neuromonitoring Changes During Pediatric Coronal Spinal Deformity Surgery. Global Spine J. 9; 1: 15S-21S. https://doi.org/10.1177/2192568219836993; PMid:31157143 PMCid:PMC6512195
Li M, Ni J, Fang X, Liu H, Zhu X, He S et al. (2009). Comparison of selective anterior versus posterior screw instrumentation in Lenke 5C adolescent idiopathic scoliosis. Spine. 34 (11): 1162-1166. https://doi.org/10.1097/BRS.0b013e31819e2b16; PMid:19444064
Lonner BS, Ren Y, Upasani VV, Marks MM, Newton PO, Samdani AF et al. (2018). Disc degeneration in unfused caudal motion segments ten years following surgery for adolescent idiopathic scoliosis. Spine Deformity. 6 (6): 684-690. https://doi.org/10.1016/j.jspd.2018.03.013; PMid:30348344
O'Donnell C, Michael N, Pan X, Emans J, Garg S, Erickson M. (2018). Anterior spinal fusion and posterior spinal fusion both effectively treat lenke type 5 curves in adolescent idiopathic scoliosis: a multicenter study. Spine Deform. 6 (3): 231-240. https://doi.org/10.1016/j.jspd.2017.09.054; PMid:29735131
Raynor B, Bright J, Lenke LG, Rahman R. (2013, Jan 15). Significant change or loss of intraooerative monitoring data: a 25 years experience in 12375 surgeries. Spine (Phila Pa 1976). 38 (2): E101-E108. https://doi.org/10.1097/BRS.0b013e31827aafb9; PMid:23124262
Schwab F, Blondel B, Chay E, Demakakos J, Lenke L, Tropiano P et al. (2014, Jan). The comprehensive anatomical spinal osteotomy classification. Neurosurgery. 74 (1): 112-120; discussion 120. https://doi.org/10.1227/NEU.0000000000000182o; PMid:24356197
Shaahen M, Koltsov JCB, Cohen SA, Langer JL. (2022). Complication risks and costs associated with Ponte osteotomies in surgical treatment of adolescent idiopathic scoliosis: insights from a national database. Spine Deformity J. 10: 1339-1348. https://doi.org/10.1007/s43390-022-00534-4; PMid:35810408
Shufflebarger HL, Geck MJ, Clark CE. (2004). The posterior approach for lumbar and thoracolumbar adolescent idiopathic scoliosis: posterior shortening and pedicle screws. Spine (Phila Pa 1976). 29 (3): 269-276; discussion 276. https://doi.org/10.1097/01.BRS.0000109881.63411.48; PMid:14752348
Suk SI, Kim JH, Kim WJ, Lee SM, Chung ER, Nah KH. (2002). Posterior vertebral column resection for severe spinal deformities. Spine (Phila Pa 1976). 27: 2374-2382. https://doi.org/10.1097/00007632-200211010-00012; PMid:12438987
Weiss HR, Goodall D. (2008, Aug 5). Rate of complications in scoliosis surgery - a systematic review of the Pub Med literature. Scoliosis. 3: 9. https://doi.org/10.1186/1748-7161-3-9; PMid:18681956 PMCid:PMC2525632
Mezentsev AA. (2003). Peredne-zadniy spondylodes pry khyrurhycheskoi korrektsii tiazhelikh skolyotycheskykh deformatsii pozvonochnika. Litopys travmatolohii ta ortopedii. 1-2: 8-10.
Copyright (c) 2023 Paediatric Surgery (Ukraine)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The policy of the Journal “PAEDIATRIC SURGERY. UKRAINE” is compatible with the vast majority of funders' of open access and self-archiving policies. The journal provides immediate open access route being convinced that everyone – not only scientists - can benefit from research results, and publishes articles exclusively under open access distribution, with a Creative Commons Attribution-Noncommercial 4.0 international license(СС BY-NC).
Authors transfer the copyright to the Journal “PAEDIATRIC SURGERY.UKRAINE” when the manuscript is accepted for publication. Authors declare that this manuscript has not been published nor is under simultaneous consideration for publication elsewhere. After publication, the articles become freely available on-line to the public.
Readers have the right to use, distribute, and reproduce articles in any medium, provided the articles and the journal are properly cited.
The use of published materials for commercial purposes is strongly prohibited.