Comparison of anterior/posterior vertebral column resection versus anterior/posterior spinal fusion for severe and rigid scoliosis

Publication date: Available online 14 October 2017
Source:The Spine Journal
Author(s): Chunguang Zhou, Limin Liu, Yueming Song, Ganjun Feng, Xi Yang, Lei Wang
Background ContextMany different correction methods have been reported to treat severe and rigid scoliosis. In the past, anterior/posterior spinal fusion (APSF), which included an anterior release followed by posterior instrumented fusion was widely applied. In recent years, anterior/posterior vertebral column resection (APVCR) is used to treat severe and rigid scoliosis.PurposeTo compare the clinical results of APSF and APVCR for severe and rigid scoliosis.Study DesignA retrospective, one center, institutional review board approved study.Patient SampleA total of 48 patients with severe and rigid scoliosis treated by APSF or APVCR were enrolled.Outcome MeasuresComparisons between groups were made regarding the following variables: age at surgery, gender, etiology, flexibility of main curve, anterior release length, posterior fusion length, screw number, operation time, estimated blood loss, hospitalization time, follow-up duration, different radiological parameters, complication rate, and SRS-22 scores.MethodsAccording to the operating technique, 48 patients with severe and rigid scoliosis were divided into two groups. In the first group, 26 patients were treated by APSF. In the second group, 22 patients were treated by APVCR. All patients had a minimum 2-year follow-up. The radiographic parameters as well as anterior release length, posterior fusion length, screw number, operation time, estimated blood loss, hospitalization time, complication rate, and demographic data were analyzed.ResultsThere was no significant difference in age, gender, etiology, flexibility of main curve, anterior release length, posterior fusion length, screw number, and follow-up between two groups. APVCR group had longer operation and hospitalization time, and more blood loss. There was no significant difference in the preoperative main curve between two groups, but APVCR group had smaller main curve of postoperation and final follow-up, and higher correction rate of immediate postoperation and final follow-up. There was no significant difference in the preoperative, postoperative and final follow-up thoracic kyphosis, coronal and sagittal balance between two groups. There was no significant difference in complication rate between two groups. Analysis of the preoperative SRS-22 questionnaire revealed no difference between 2 groups. At final follow-up, APSF and APVCR groups had similar scores in the function, pain, self-image, mental health, and satisfaction with the treatment domains.ConclusionsCompared with APSF, to treat severe and rigid scoliosis by APVCR means longer operation and hospitalization time, more blood loss, and better correction rate of main curve, but similar SRS-22 questionnaire scores improvement.



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