Abstract
Introduction: In cases of severe, rigid scoliotic curves, anterior or posterior fusion alone is inadequate and surgical treatment with a combined anterior and posterior) approach is required. The purpose of this study is to evaluate the effectiveness and the complications of these lengthy procedures.
Material and Methods: Between 1993 and 2002, 125 patients with scoliosis were surgically treated in our department. A total of 18 patients with scoliosis were treated with a combined anterior and posterior approach. The mean age of these patients was 19.6 years (range 5.5 – 60 years). Fourteen patients were subjected to a single-stage procedure, while 4 patients underwent a staged procedure. Thirteen patients underwent anterior release and posterior nstrumentation, while 5 patients underwent both anterior and posterior instrumentation. Additional thoracoplasty was performed in 3 cases. The mean duration of the operation was 12.1 hours (range 4.5 – 14 hours). All patients were monitored postoperatively in the Intensive Care Unit. The mean duration of follow-up was 4.5 years (0.6 – 9 years).
Results: Anterior release and posterior instrumentation achieved a mean 30% correction of curves that were corrected by only 15% with traction preoperatively. Combined anterior and posterior nstrumentation achieved a mean 44% correction of curves that were corrected by only 22% with traction preoperatively. One patient presented residual pneumothorax that was treated with chest tube. One patient with neuromuscular scoliosis presented wound dehiscence and early infection, which led to removal of the posterior instrumentation.
Conclusions: A combined anterior and posterior procedure is indicated in patients with severe, rigid curves. It achieves greater correction, and prevents the crankshaft phenomenon in immature patients. We recommend the single-stage procedure (if patient general condition permits), because: 1) total anesthesia time is reduced, 2) total intraoperative blood loss is reduced, 3) hospital stay is reduced, and 4) greater curve correction is achieved. Severe complications include respiratory dysfunction and diffuse intravascular coagulation in multiply transfused patients, especially with use of an intraoperative autotransfusion device.
The abstracts were prepared by Eleni Koutsoukou. Correspondence should be addressed to him at the Hellenic Association of Orthopaedic Surgery and Traumatology (HAOST), 20, A. Fleming str, 15123 Marousi, Athens, Greece.
