Classic management of large and stiff thoracic scoliotic curves in the adolescent comprise of anterior release followed by posterior instrumentation. However third generation segmental spinal instrumentations have shown increased correction of thoracic curves. Therefore, the indication for an anterior release may no longer be required. We reviewed our database for cases with thoracic curves with Cobb angle between 70 and 90° that we had only done posterior surgery. We found that with adequate posterior release, and the use of third generation segmental instrumentation there is no need for anterior release even for curves in the 70–90° range.

Large and stiff thoracic scoliotic curves in the adolescent represent a classic indication of anterior release before posterior spinal instrumentation.

To assess if third generation segmental posterior instrumentation can omit the need of anterior surgery in large and stiff thoracic curves.

An independent observer, reviewed in a retrospective fashion our electronic database of adolescent scoliosis surgery (Scolisoft) with the following query: Thoracic curves, Cobb angle between 70 and 90° degrees and posterior surgery only. There was nineteen patients who fit the criteria. Out of these, four were judged to flexible (bends < than 45°) and were not included. Fifteen patients (mean age 13.6) with thoracic scoliosis with average Cobb 78.5° with a flexibility index of 32.5% were analyzed. (mean f/u: twenty-eight months)

Postoperatively the thoracic Cobb angle measured on average 34.8° (25° −45°), which represents a correction rate of 54 % (range, 40.0–67.1%) and remained unchanged at the last follow-up (35°). Sagittal alignment improved from an average 11° to 18°. There were two complications (one excessive bleeding and one infection). Coronal balance was improved, as was shoulder balance. All patients reported satisfactory results except the patient with an adding-on phenomena

In the literature most of the results of anterior thora-coscopic release and posterior surgery give a percentage of Cobb angle correction similar or inferior (averaging 50%) to our series for an average initial Cobb angle of less magnitude. With adequate posterior release, and the use of third generation segmental instrumentation there is no need for anterior release even for curves in the 70–90° range.