Abstract
This paper reviews 32 patients (seven boys and 25 girls, mean age 14.5 years) with adolescent idiopathic scoliosis treated by anterior spinal release, fusion and instrumentation from 1989 to 2001. In 22 patients the thoracic curve was involved, in six the thoracolumbar and in four the lumbar curve. The mean preoperative kyphosis (thoracic curves) was 22.3° and the mean Cobb Angle was 56°. Routine exposure through the convexity was performed (sixth rib for thoracic curve and 10th rib for other curves).
After discectomy (four to nine levels), morselised rib was used as bone graft and instrumentation was applied with correction of deformity and saggital profile. Costo-plasty was performed in 10 patients. The mean operation time was three hours; mean blood loss was 180 ml. Intraoperative problems were partial pull-out of screws from the first proximal vertebra in three patients. In one asthmatic patient, who was on steroids, instrumentation was abandoned because of pull-out of several screws.
The mean hospital stay was 10 days. Two patients developed superficial wound sepsis and one sustained a burn to the right shoulder (cause unknown). Rod breakage occurred in two patients. Angulation at the level below the lowest instrumented vertebra occurred in five patients and was attributed to inappropriate fusion levels. Pseudarthrosis developed in two patients. At final follow-up, the mean Cobb angle was 26° and the mean thoracic kyphosis 30°.
The advantages of anterior surgery for idiopathic scoliosis include fewer fusion levels, correction by shortening the spinal column and less blood loss. Difficulty may be encountered in selection of fusion levels and instrumentation of the proximal vertebrae. In cases of very rigid curves, posterior spinal release may improve results.
The abstracts were prepared by Professor M. B. E. Sweet. Correspondence should be addressed to him at PO Box 47363, Parklands, Johannesburg 2121, South Africa.
