Abstract
Background: Patients with adolescent idiopathic scoliosis (AIS) exceeding fifty degrees or more at maturity are at risk for continuous progression. For curves in the thoracolumbar or lumbar region vertebral olisthesis, with severe low back pain with or without radicular pain, may result. Conventional techniques with anterior, posterior or combined approaches often fail to achieve a good alignment. The technique described by Bradford employing a shortening osteotomy at the apical segments can be used in very stiff curves with translations.
Methods: Three women with AIS and successive curve deterioration were treated by means of shortening osteotomy at our institution. The mean age was 40 (48–35) years and the follow up was 26 (60–8) months. The resected vertebrae were L1 in two cases and L2 in one. The operations were staged, initially anterior discectomies were performed. A flap of the vertebral wall was then raised and a total resection of the vertebral body and the convex pedicle was undertaken. After protection of the dual sac with a Spongostan film, the harvested bone was impacted into the defect. One week later, the remnants of the vertebra were removed posteriorly following temporary stabilization. Correction was achieved by compression.
Results: Two osteotomies united and the patients are pain free, in good balance and back at work. The other case had a temporary partial drop foot on one side, however radiographically is progressing well and she remains in rehabilitation. There have been no implant related complications.
Conclusion: Shortening osteotomy appears to be a good technique when treating adult patients with late rigid, painful scoliotic deformities of the thoracolumbar region.
The abstracts were prepared by Mr Colin E. Bruce. Correspondence should be addressed to Colin E. Bruce, Consultant Orthopaedic Surgeon, Alder Hey Children’s Hospital, Eaton Road, Liverpool, L12 2AP.
