Posterior Instrumentation and Fusion in Multiple-segment Adolescent Congenital Scoliosis: When are Posterior Column and Concave Rib Osteotomies Needed?


Yucekul A. , Ramazanov R., Olgun Z. D. , Ayvaz M., Demirkiran G., Bekmez S., ...More

Journal of pediatric orthopedics, vol.41, 2021 (Journal Indexed in SCI) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 41
  • Publication Date: 2021
  • Doi Number: 10.1097/bpo.0000000000001841
  • Title of Journal : Journal of pediatric orthopedics
  • Keywords: congenital scoliosis, traction radiograph under general anesthesia, curve flexibility, posterior instrumentation and fusion, posterior column osteotomies, concave rib osteotomies, blood loss, adolescent, CURVE FLEXIBILITY, RESECTION, KYPHOSIS, TRACTION, ANOMALIES

Abstract

Background: No clear guidelines exist for appropriate surgical treatment of congenital scoliosis. The spectrum varies from isolated posterior instrumentation and fusion (PIF-only) to vertebral column resections. Multiple posterior column osteotomies (PCOs) with and without concave rib osteotomies have previously been suggested as an alternative to invasive 3-column osteotomies. The aim of the study is to analyze outcomes of spinal surgery in congenital scoliosis patients for a new treatment algorithm based on a traction radiograph under general anesthesia (TruGA). Methods: Surgical intervention was determined according to flexibility with TruGA: patients with >40% correction underwent PIF-only; patients with <40% of correction underwent PCO. Patients, who had <30% of correction in TruGA and/or more than 5 vertebral levels with failure of segmentation, underwent additional concave rib osteotomies. The radiologic and clinical results were compared. Results: Forty-three patients met inclusion criteria (14M). The mean age was 13.8 (10 to 17) years, average follow-up 67 (24 to 107) months. Fourteen patients were in the PIF-only group, 29 in the PCO group. PCO patients were significantly older (14.5 vs. 12.3, P=0.001). Mean operative time and blood loss of PCO group were significantly greater than those of PIF-only group. Nine patients required concave rib osteotomies. While the curve magnitude of patients in the PIF-only and PCO groups did not differ significantly (54.6 vs. 63 degrees, P=0.067), curve rigidity was significantly higher in the patients of PCO group (51.2% vs. 32%, P=0.001). Despite this, postoperative correction rates for 2 groups were similar (51.1% vs. 47.8%, P=0.545). Conclusions: The number of anomalous segments and the curve flexibility on TruGA play important roles in the decision-making process in congenital scoliosis and