Comparison Of Two Techniques In Severe And Rigid Idiopathic Thoracolumbar Scoliosis:Anterior-posterior Instrumentation Versus Posterior Vertebral Column Osteotomy

Background and Objective To evaluate the efficacy of the two techniques in the treatment of severe and rigid idiopathic thoracolumbar scoliosis:anterior-posterior Instrumentation versus posterior vertebral column osteotomy.Materials and methods A total of32cases of severe thoracolumbar idiopathic scoliosis cases,11males and21females. The average age was15.9years.15patients underwent a staged anterior release and posterior fusion;17patients underwent one-stage posterior vertebral column osteotomy. All radiographic measurements were made on the preoperative, immediate postoperative, and final postoperative radiographs of every patient. Radiographic analysis included Cobb measurements of the coronal and sagittal plane. Curve flexibility was determined on the preoperative supine side-bending anteroposterior radiographs.The medical records were reviewed and the complications were recorded.Result All patients had been followed up for more than1year, the average follow-up time was46months. There were no statistically significant differences between the groups for preoperative coronal/sagittal Cobb measurements, coronal curve flexibility, or amount of postoperative and the last follow-up coronal/sagittal Cobb correction.(P>0.05). However, the anterior and posterior group demonstrated longer operative time and hospital days compared with the posterior groups(P<0.05).But the posterior group had a more Bleeding loss. Complications:the anterior and posterior group included lung injury in1case, traumatic pleurisy and pleural effusion in1case and sympathetic injury in4cases. The posterior group included cerebrospinal fluid leakage in1case and transient nerve root palsies in1case.Conclusions The two techniques can get similar effect in the treatment of severe idiopathic thoracolumbar scoliosis. Compared to anterior and posterior group, posterior group has a shorter surgery time, the lower probability of neurological complications, but the larger amount of bleeding loss. With the improvement of surgical techniques, posterior vertebral column osteotomy is still the main method for the treatment of severe idiopathic thoracolumbar scoliosis.