Evaluation And Treatment Of Congenital Scoliosis With Failure Of Segmentation In Adolescent

Objective: To evaluate the early clinical efficacy and safety of concave costovertebraljoint release(CCJR) with single-end wedge osteotomy (SEWO) or both-ends wedgeosteotomy(BEWO) via posterior approach for congenital scoliosis with failure ofsegmentation.Method: From November2004to December2009,24patients due to congenitalscoliosis with failure of segmentation undergone a CCJR with SEWO (10cases) orBEWO (14cases) via a posterior-only approach,12males and12females with anaverage of16.7years (range,13~22years). The mean scoliotic Cobb angle was84.1°(50°～139°). The average spinal flexibility of scoliosis was17.0%(5.1%～30.0%). The coronal imbalance is2.54cm (range,0.8～6.3cm).18of the whole had anunsegmented bar at one site,3at two sites and3at three sites.Result: The average surgical time was7.9hours (range,5.3~11.2hours) and theaverage volume of blood loss was2980ml (range,1500~4500ml). There was no case ofneurological defict as the osteotomy gap was close by compression. One case hadhemopneumothoraxes intra-operatively and then was treated with chest cavity closedtype drainage with completely recovery after2weeks. One case had incomplete leftlower limb paralysis due to the pedicle screw, which invaded the T5spinal canals andcompressed the spine cord. The screw was removed postoperative. The function of theleft limb recovered completely three months after the operations. At immediateassessment after operation, the mean scoliotic Cobb angle was26.8°(6°~51°) with scoliosis correction of68.8%（52.7%~90.9%）. The coronal imbalance improved to0.76cm (range0.3～2.5cm), a65.7%（12.5%~89.5%）correction. The patients werefollowed up with an average of32.2months. At final follow up, the mean scolioticCobb angle was28.6°(9°~53°) with scoliosis correction of66.7%（50.5%~87.2%）andthe correction loss averaged2.1%on average. The coronal imbalance is0.81cm(range0.3~2.6cm), a63.3%（12.5%~89.5%）correction and the correction loss averaged2.4%. Bony fusion was achieved in all patients, and no instrument complicatioins aswell as no significant correction loss was documented.Conclusion: CCJR with SEWO or BEWO via posterior approach can improve thespinal flexibility and safety as the osteotomy gap was close by compression, which is areliable and effective method to achieve a good capability of correction for congenitalscoliosis with failure of segmentation.