Study design: Retrospective study.
Objective: To report on the results of anterior release, posterior internal distraction (with or without further distraction), and subsequent posterior spinal fusion for severe and rigid scoliosis.
Summary of background data: For severe and rigid scoliosis, conventional procedures, such as posterior instrumentation combined with an anterior release, enable limited correction. Posterior vertebral column resection brings better correction but with a high rate of neurological complications or intraoperative neurological events.
Methods: A total of 15 patients with severe and rigid scoliosis who underwent anterior release, posterior internal distraction (with or without further distraction), and subsequent posterior spinal fusion were retrospectively reviewed after a minimum follow-up of 2 years. The radiographical parameters were evaluated, and clinical records were reviewed.
Results: The average number of anteriorly removed discs was 4.1. Average posterior fusion length comprised 14.3 vertebrae. Overall, internal distraction corrected the mean Cobb angle by 58.1% (from 105.1° to 44.2°) compared with the initial curve magnitude. The mean preoperative scoliosis of 105.1° was corrected to 27.5° (74.3% correction) at the most recent follow-up. The correction rate of the proximal thoracic and thoracolumbar or lumbar curves was 48.1% and 82.1%, respectively. The preoperative thoracic kyphosis of 62.3° was corrected to 33.8° at the most recent follow-up. The preoperative lumbar lordosis of -66.1° was corrected to -46.3° at the most recent follow-up. The mean preoperative coronal imbalance of 0.8 cm improved to 0.5 cm at the most recent follow-up, and sagittal imbalance of 0.3 cm improved to 0.2 cm. Transient dyspnea occurred in one patient after the initial surgery and subsequently resolved. Two patients complained of concave soft-tissue pain after the first distraction. There were no neurological complications.
Conclusion: Anterior release, posterior internal distraction, and subsequent posterior spinal fusion provide an effective alternative for severe and rigid scoliosis.
Level of evidence: 4.