The influence of distraction times on the surgical outcome in severe rigid scoliosis

English Keywords:Severe rigid scoliosis  Posterior distraction  Trunk balance  Health economics

English Abstract:

  【Abstract】 Objectives: To investigate the improvement in the trunk balance following staged anterior release, internal distraction, posterior fusion in the treatment of severe and rigid scoliosis, and to compare the economic costs between the one-time distraction group and two-time distraction group. Methods: From January 2010 to January 2014, 23 patients with severe and rigid scoliosis(Cobb angle>90°, flexibility<30％) were included in this study and devided into one-time distraction or two-time distraction group. For all patients, the primary surgery included anterior release and the first distraction, in the two-times distraction group, the second distraction was conducted 10 days after the first distraction, both groups had the final fusion surgery 2 weeks after the distraction procedure. Radiographs on trunk balance, clinical records on health economic results(including complications, blood loss, operation time, hospital stay and hospital costs) were reviewed to evaluate the surgical result; and compared between two groups. Results: A total of 23 patients was included in the study, 11 in the one-time distraction group, 12 in the two-time distraction group, there was no significant difference in preoperative major curve Cobb angle, flexibility of major curve, coronary imbalance, sagittal imbalance, thoracic kyphosis, and lumbar lordosis between two groups. After the surgery, the Cobb angle of major curve, coronary balance, sagittal balance improved significantly in both groups compared with the preoperative ones(P＜0.05), but no statistical difference was noted between two groups(P>0.05). After the second distraction in the two-time distraction group, apart from major curve Cobb angle, there was no significant improvement of the balance parameters compared with those after the first distraction(P＞0.05). In the one-time distraction group, the average total blood loss, the mean operation time, the total hospital stay and the mean hospital cost were significantly less than those of the two-time distraction group. Two cases in the two-time distraction groups were noted complications(1 case with pleura effusion, 1 with lower extremity numbness, both were fully recovered after appropriate treatment), while none in the one-time distraction group. Conclusions: Anterior release, internal distraction and posterior fusion surgery can effectively correct the scoliosis and guarantee the level of trunk balance. Two-time distraction can further increase the correction of trunk balance to a limit degree, but considering the risk of complications and cost necessitated, a second distraction should be considered cautiously.