The impact of posterior temporary internal distraction on stepwise corrective surgery for extremely severe and rigid scoliosis greater than 130°

Abstract

Aim

To investigate the efficacy and safety of temporary internal distraction corrective surgery for extremely severe scoliosis.

Methods

Eleven scoliosis patients (3 males and 8 females) with curves ≥130° (mean 148.8°; range 130°–157°) who underwent a two-stage surgery, including a posterior temporary internal distraction correction and definitive posterior spinal correction with posterior pedicle screw instrumentation from 2008 to 2011 were retrospectively reviewed. Minimum follow-up was 2-years (mean 41.8 months; range 27.0–63.0 months). The analysis focused on the impact of temporary internal distraction on curve correction, pulmonary function tests (PFTs), complications and surgical outcomes. Neurosurveillance of sensory (somatosensory-evoked potentials) and motor (motor-evoked potentials) potential was performed in all cases. Posterior instrumentation was used in all patients.

Results

After the use of internal distraction, the preoperative major curve (mean 148.8°; range 130°–157°) was corrected to a mean of 79° (range 63°–87°), the T5–T12 kyphosis Cobb angle (mean 79°; range 30°–97°) was corrected to a mean of 59° (range 20°–75°), the coronal imbalance (mean 0.8 cm; range −3.6 to 2.8 cm) was improved to a mean of 0.6 cm (range −1.5 to 2.0 cm), the forced vital capacity percentage (FVC%) was improved from 59.3 ± 11.6 to 68.7 ± 13.7, and the forced expiratory volume in 1 s (FEV1%) was improved from 61.4 ± 13.6 to 71.3 ± 9.3. The average increase in body height was 6.7 cm, and the dorsum razor was corrected to 3–5 cm. During definitive surgery, the final major curves were corrected to a mean of 55° (range 32°–72°), the T5–T12 kyphosis Cobb was corrected to 35° (range 15°–68°), the coronal imbalance was improved to 0.5 cm (range −1.2 to 1.8 cm), the FVC% was improved to 71.2 ± 8.3, the FEV1% was improved to 76.3 ± 16.7, the increase in body height was 3.1 cm, and the dorsum razor was corrected to 1–3 cm. The mean interval time between the two surgeries was 3.5 months. None of the patients exhibited postoperative neurologic deficits or infections. No instrument complications were found during the final follow-up.

Conclusions

Temporary internal distraction in a two-stage corrective surgery provided patients who had extremely severe and rigid scoliosis, an effective and safe solution for scoliosis without significant complications.

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Hu, HM., Hui, H., Zhang, HP. et al. The impact of posterior temporary internal distraction on stepwise corrective surgery for extremely severe and rigid scoliosis greater than 130°. Eur Spine J 25, 557–568 (2016). https://doi.org/10.1007/s00586-015-4013-z

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Keywords

  • Severe and rigid scoliosis
  • Internal distraction
  • Posterior fusion
  • Surgical procedure