Anterior Release Internal Distraction and Posterior Spinal Fusion for Severe and Rigid Scoliosis

作者：Zhou, Chunguang; Liu, Limin^*; Song, Yueming; Liu, Hao; Li, Tao; Gong, Quan; Zeng, Jiancheng; Kong, Qingquan

来源：Spine, 2013, 38(22): E1411-E1417.

DOI：10.1097/BRS.0b013e3182a3cd90

• severe and rigid scoliosis
• internal distraction
• anterior release
• posterior instrumentation
• posterior fusion

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 degrees to 44.2 degrees compared with the initial curve magnitude. The mean preoperative scoliosis of 105.1 degrees was corrected to 27.5 degrees (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 degrees was corrected to 33.8 degrees at the most recent follow-up. The preoperative lumbar lordosis of -66.1 degrees was corrected to -46.3 degrees 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 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.

• 出版日期2013-10-15
• 单位四川大学