| Objective:Flat back syndrome in is an important sagittal deformity inidiopathic scoliosis. Thoracic kyphosis angle is smaller than normal in this syndrome.The loss of thoracic kyphosis can affect the volume of thoracic cage and the sagittalbalance of whole spine. This study were performed to evaluate whether the posteriorapproach surgery with multilevelPonteosteotomiescan restore the thoracic kyphosisin idiopathic scoliosis.Methods:Idiopathic scoliosis patients were included for two researches. In thefirst research,42thoracic idiopathic scoliosis patients whose thoracic Cobb anglewere smaller than70degrees were corrected with posterior pedicle screw systembetweenMarch2008and February2010.33were female and9were male. Theiraverage age was16years (12~20years) at operation. Neither of the42cases hasasagittal thoracic Cobb lager than40degrees. They were separated into2groups. Onegroup of17cases were treated with multilevel Ponte osteotomies for posteriorrelease. The other group of25cases had only posterior soft tissue release with noosteotomies. In the second research,37idiopathic scoliosis patients (26female and11male) with severe and rigid thoracic curvescorrected with posterior pedicle screwsystem between2006and2009were included. Their average age was17.3years (14~22years) at operation and the thoracic Cobb angle was between70-100°. Theywere separated into2groups. Group A of15cases were treated with wide posteriorrelease. Group B of22cases had only posterior soft tissue released. The preoperative,postoperative instant and latest standing posteroanterior and lateral radiographs were reviewed.Results: All patients were operated successfully. In the first research, theaverage operation time was248min in the Ponte osteotomies group and192min inthe soft tissue release group.The average blood loss was859ml in the Ponteosteotomies group and742ml in the soft tissue release group. The average coronalCobb angle in postoperative standing photograph was15.4degrees (73.2%correction)in the Ponte osteotomies group and13.6degrees (74.8%correction) in the soft tissuerelease group. The sagittal thoracic Cobb was28.9degrees (11.4degrees more thanpre-operation) in the Ponte osteotomies group and19.8degrees (1.2degrees morethan pre-operation) in the soft tissue release group.No nerve system injury, infectionand instrumentation failure were found. With a follow-up of2years, no obviouscorrection loss and no trunk decompensation appeared.The trunks translation and theshoulders difference in height were within2cm. In the second research, there was nostatistic difference in the average operation time between the two groups（P>0.05）.The average blood loss was874ml in Group A and712ml in Group B（P<0.05）. The average coronal Cobb angle in postoperative standing photographwas27.4°(68.1％correction) in Group A and35.6°(56.9％correction) in Group B.In order to contrast sagittal correction results in patients with similar thoracic sagittaldeformities, we distinguished Subgroup A1(preoperative TKA<40°) fromSubgroup A2(preoperative TKA>40°) in Group A and Subgroup B1(preoperativeTKA<40°) from Subgroup B2(preoperative TKA>40°) in Group B. Thepostoperative TKA was26.8°(9.2°more than pre-operation) in Subgroup A1and12.5°(3.1°less than pre-operation) in Subgroup B1（P<0.05）.The postoperativeTKA was28.4°(24.9°less than pre-operation) in Subgroup A2and39.1°(10.3° less than pre-operation) in Subgroup B2（P<0.05）.No nerve system injury, deepinfection and instrumentation failure were found. With a follow-up of2years, noobvious correction loss and no trunk decompensation appeared.Conclusions: In Lenke1idiopathic scoliosis patients, the posterior approachsurgery with multilevelPonteosteotomiescan restore the thoracic kyphosis butcreateno coronal correction deference. In the idiopathic scoliosis patients with severe andrigid thoracic curves, wide posterior release withPonteosteotomies in the posteriorapproach surgery can help to correct the deformity in sagittal plane andachieve morecoronal correction. |
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