Posterior concave side release plus double wedge-osteotomy at both ends for severe congenital scoliosis

English Keywords:Severe congenital scoliosis  Unilate unsegmented bar  Concave release  Double wedge-osteotomy  Posterior approach

English Abstract:

  【Abstract】 Objectives: To investigate the clinical outcome and reliability of posterior concave side release plus double wedge-osteotomy at both ends for severe congenital scoliosis. Methods: From November 2004 to October 2009, 14 patients suffering from severe congenital scoliosis underwent posterior costotransversectomy release at concave side and double wedge-osteotomy at both ends. There were 8 males and 6 females with an average age of 17.6 years (range, 14-22 years old). The average pre-operative Cobb angle of scoliosis was 99.4°(range, 83°-139°); the average spinal flexibility of scoliosis was 14.3% (range, 7.8％-20.1%). The average vertical distance between C7 and center of sacral line was 3.4cm(range, 0.8-6.3cm). The clinical data including operation time, blood loss, complications, rate of correction immediately after operation and at last follow-up were reviewed retrospectively. Results: The average operation time was 8.6 hours with an average blood loss of 3750ml (3100-4500ml). The average number of costocentral joint released ｗａｓ 5.2(4-6). One case presented with paralysis at left lower limb due to the T5 spinal canal penetration by pedicle screw, and the screw was removed. The neurofunction of the left limb recovered completely three months later. 1 patient developed hemopneumothorax during operation, which was resolved completely after chest cavity close drainage for 2 weeks. All patients were followed up for an average of 32.6 months (range, 24-48 months). At final follow-up, the average Cobb angle was 34.9°(range, 12°-53°), with a correction rate of 65.3%. The average post-operative vertical distance between C7 and center of sacral line was 1.0(range, 0.4-2.6cm), with an average correction of 65.9%(12.5%-89.5%). Bony fusion was achieved in all patients, and no instrument failure or significant loss of correction was noted. Conclusions: Concave side costotransversectony release and wedge-osteotomy at both ends can improve the spinal flexibility and stability, which is a safe and effective alternative to achieve correction.