Analysis of the results of surgical treatment in idiopathic thoracic scoliosis with Cobb angle 80º-100º

Abstract

Anterior spinal mobilization is an effective method of staged correction of thoracic idiopathic scoliosis with a Cobb angle of 80-100º. The introduction of modern transpedicular implants and osteotomies of the posterior support complex into clinical practice has reduced the frequency of its use, but increased the number of neurological complications. Purpose - to compare the results of anterior mobilization in combination with posterior corrective fusion and posterior corrective fusion alone in patients with stiff thoracic idiopathic scoliosis. Materials and methods. A retrospective comparative analysis of the results of surgical treatment of 167 patients with thoracic idiopathic scoliosis with a Cobb angle of 80-100º was performed. Patients were divided into two groups: the Group 1 - 83 patients (mean age - 13.7 years) who underwent anterior curvature mobilization and posterior corrective fusion, the Group 2 - 84 patients (mean age - 14.7 years) who underwent posterior corrective fusion and Ponte osteotomy at 3-5 levels. Results. The average thoracic Cobb angle before surgery in the Group 1 was 87.1º (±1.96), in the Group 2 - 83.8º (±2.85); after surgery - 32.2º (±2.24), or 63% correction, and 44.2º (±3.22), or 47% correction, respectively. The total average duration of surgical interventions in the Group 1 was 410 minutes (140 minutes + 270 minutes), in the Group 2 - 320 minutes. Intraoperative blood loss was 890 ml and 900 ml, respectively. The average volume of haemotransfusion was 650 ml and 672 ml, respectively. The average hospital stay was 15.6 days and 8.6 days, respectively. Conclusions. Compared with posterior corrective fusion, the use of two-stage treatment, which includes anterior mobilization of the curvature and posterior corrective fusion for surgical correction of stiff scoliotic spinal deformities, allows to increase the intraoperative correction of the main curvature by 17%. The study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee of all the institutions mentioned in the study. Informed consent was obtained from the patients. No conflict of interests was declared by the authors.