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Abstract
Objectives
To report the surgical technique and effectiveness in treating rigid adult scoliosis with one stage vertebral column resection and pedicle screw fixation through a single posterior approach(PVCR).
Materials and Methods
Twenty- one patients with low flexibility(less than 20~30%) subjected to PVCR were evaluated after a mean followup of 18.5 months(12~29 months). There were 10 males and 11 females. The mean age at the time of the operation was 32.1 years(19~61 years). Etiological diagnoses were idiopathic in 7, congenital in 12, neuromuscular in 2. Preoperatively, all the patients showed moderate to severe derangement of pulmonary function with reduced vital capacity(30%~57%).
Results
A n average of 1.3 vertebrae(1~3 vertebrae) were removed. The resection of body was in thoracic in 12 and lumbar in 15. Posterior fusion was carried out in 6.8(3~12) levels. Following the surgery, preoperative thoracic scoliosis of 86˚(55~130˚) and lumbar scoliosis of 64˚(35~110˚) were corrected to 38˚(15~65˚) and 25˚(14~61˚), showing a correction of 56.2%(39~78%) and 61.1%(44~82%) respectively. Preoperative kyphosis of 59˚(1 6~10 4˚) was corrected to 24 ˚ (2~58˚), showing a correction of 60.2%(41~74%). Preoperative coronal imbalance and shoulder height difference was corrected to 0.6 cm and 1.0 cm respectively. The average operation time and transfusion were 253 minutes and 2835 ml. The complications comprised two transient neurological deficits, one aggravated neurological deficits, one monoparesis, one infection, and one pneumothorax.
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Figures and Tables%
Fig. 3.
Deformity correction was carried out by compression and shortening of the vertebral column for each additional attempt of increasing the correction.
Fig. 4.
A 41-years old male with severe thoracic scoliosis (116˚) and trunk imbalance. After T8 vertebra including upper and lower discs were resected, cage was inserted for anterior support. Postoperatirely, thoracic curver was corrected to 55˚ with satisfactory trunk balance.
Fig. 5.
Same patient with thoracic kyphosis of 120 degrees on lateral scanogram. Following PVCR, kyphosis was improved to 40 degrees with excellent sagittal balance.
Table 1.
Preoperatively curve characteristics
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