Chao Li1, Qingsong Fu, Yu Zhou, Haiyang Yu, Gang Zhao. 1. Department of Orthopedic Surgery, Fuyang People's Hospital, Anhui Medical University, Fuyang city, Anhui Province, China. fylichao2008@sina.com
Abstract
STUDY DESIGN: Retrospective clinical case series. OBJECTIVE: 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. SUMMARY OF BACKGROUND DATA: Conventional surgical correction techniques for severe rigid scoliosis include anterior release combined with posterior instrumentation and fusion and vertebral column resection. METHODS: 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). RESULTS: 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. CONCLUSION: 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.
STUDY DESIGN: Retrospective clinical case series. OBJECTIVE: 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. SUMMARY OF BACKGROUND DATA: Conventional surgical correction techniques for severe rigid scoliosis include anterior release combined with posterior instrumentation and fusion and vertebral column resection. METHODS: 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). RESULTS: 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. CONCLUSION: 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.