Combined anterior/posterior scoliosis surgery is the mainstay of scoliosis surgery in large curves with Cobb angle more than 65°, in stiff curves that correct to above 40° only on the pre-operative bending films and in Steersman’s kyphosis greater than 90°. The combined anterior/posterior scoliosis surgery allows better correction of the curve, saving motion segments in the spine and eliminating the occurrence of the crankshaft phenomenon. Video-assisted spinal surgery (VATS) and Mini open thoracotomy, thoracoscopically assisted (MOT-TA) allow for the performing of multi level discectomies and soft tissue release, as an anterior adjunct to posterior spine fusion, through minimal approach to the thoracic spine in scoliosis surgery. During the last year we have begun using the MOT-TA for
Scoliosis requires three dimensional correction at a global level (curve correction) and at a local one (apical axial derotation) as well as sagittal balance management. Except for in situ contouring, previously reported surgical techniques for scoliosis correction hardly deal with all these issues. The aim of the current study was to evaluate long term clinical and radiological outcomes after in situ contouring in 85 patients with severe scoliosis (Cobb= 40 to 110°). Age influence (adults versus adolescents) and surgical approaches (anterior release and posterior correction and fusion versus posterior correction and fusion only) were also assessed. The results of the study show that the in situ contouring is comparable to other surgical techniques in terms of surgery duration and blood loss. Anterior release proved useful in severe scoliosis correction. No difference in peroperative complications was found between age groups nor between approach groups. However, adolescents recover faster than adults. No difference of revision rates in double approach versus posterior approach populations was found. No statistically significant differences were found between the adolescent and adult populations. The mean overall frontal correction reached 68%. The mean loss of correction amounted 5%. No significant evolution was found in sagittal curvatures, emphasizing the difficulties in restoring physiological curvatures in patients with severe scoliosis. Our results suggest the in situ contouring technique is fully appropriate for severe scoliosis correction, regardless of the patient’s age and approach. Besides it will not result in higher morbidity for one specific population and warrants similar outcome when properly applied.
Introduction and Aims: Traditional treatment for adolescent hyperkyphosis, including Scheuermann’s disease, has included apical
Objective: Surgical correction of late-onset idiopathic scoliosis (AIS) has been shown to be effective in obtaining correction in the frontal and sagittal planes, but is of questionable benefit in reducing the rib hump in the transverse plane The purpose of this study was to assess the effects of double rod and pedicle screw (AO USS) instrumentation on transverse plane asymmetry (on the convex and concave side of the scoliosis) in a single thoracic curve type (King III). Design: A consecutive, prospectively studied cohort treated by a single surgeon with either a single-stage or two-stage procedure. Subjects: Sixty-five patients with a King III adolescent idiopathic scoliosis were studied. There were 53 females and 12 males whose mean age at surgery was 14.5 years (range 11.1 to 17.9). A single-stage posterior fusion with instrumentation was performed in 46 patients whose mean Cobb angle at surgery was 56° (range 35 to 84). A two-stage procedure with thoracotomy and