Skip to main content
Top
Published in: European Spine Journal 6/2014

01-06-2014 | Original Article

Comparison of anterior and posterior vertebral column resection versus anterior release with posterior internal distraction for severe and rigid scoliosis

Authors: Chunpeng Ren, Limin Liu, Yueming Song, Chunguang Zhou, Hao Liu, Tao Li

Published in: European Spine Journal | Issue 6/2014

Login to get access

Abstract

Purpose

This study aimed to compare efficacy, safety, and cost between staged vertebral column resection (VCR) and anterior release with internal distraction in treating severe and rigid idiopathic scoliosis.

Methods

We examined the records of 43 patients with severe and rigid idiopathic scoliosis treated in our hospital. Group A included 26 patients who underwent anterior VCR followed by posterior vertebral column resection and instrumentation from July 2007 to October 2009. Group B included 17 patients who underwent anterior release with temporary posterior internal distraction, followed by posterior fusion and instrumentation from November 2009 to June 2011. The average preoperative main curve for group A was 101.3° (range 90°–130°) and for group B was 104.8° (range 90°–136°). Minimum follow-up was 2 years. Radiographic and clinical outcomes were compared between the groups.

Results

A t test demonstrated that the differences between the groups in preoperative and postoperative coronal and sagittal imbalance, thoracic kyphosis correction, and lumbar lordosis were not statistically significant. Patients in group B showed better postoperative (P = 0.031) and final (P = 0.030) main thoracic curve correction (76.8 and 75.6 %, respectively) than patients in group A (68.3 and 67.7 %, respectively). Patients in group B had better thoracolumbar or lumbar curve correction (85.8 %) than those in group A (76.8 %; P = 0.048). The differences in blood loss and operation time were not statistically significant (P = 0.094 and P = 0.060, respectively). Hospital stay was longer (P = 0.001) and patient cost was higher (P < 0.001) for patients in group B. One patient in group A required ventilator support for 12 h after anterior surgery. One transient dyspnea occurred in group B. No neurologic deficits occurred in either group.

Conclusion

Anterior release with posterior internal distraction produces better corrective effects than anterior and posterior VCR, though hospital stay and costs are greater.
Literature
1.
go back to reference Bullmann V, Halm HF, Schulte T, Lerner T, Weber TP, Liljenqvist UR (2006) Combined anterior and posterior instrumentation in severe and rigid idiopathic scoliosis. Eur Spine J 15:440–448PubMedCentralPubMedCrossRef Bullmann V, Halm HF, Schulte T, Lerner T, Weber TP, Liljenqvist UR (2006) Combined anterior and posterior instrumentation in severe and rigid idiopathic scoliosis. Eur Spine J 15:440–448PubMedCentralPubMedCrossRef
2.
go back to reference Byrd JA 3rd, Scoles PV, Winter RB, Bradford DS, Lonstein JE, Moe JH (1987) Adult idiopathic scoliosis treated by anterior and posterior spinal fusion. J Bone Joint Surg Am 69:843–850PubMed Byrd JA 3rd, Scoles PV, Winter RB, Bradford DS, Lonstein JE, Moe JH (1987) Adult idiopathic scoliosis treated by anterior and posterior spinal fusion. J Bone Joint Surg Am 69:843–850PubMed
3.
go back to reference Klockner C, Walter G, Matussek J, Weber U (2000) Ventrodorsal correction and instrumentation in idiopathic scoliosis. Orthopade 29:571–577PubMedCrossRef Klockner C, Walter G, Matussek J, Weber U (2000) Ventrodorsal correction and instrumentation in idiopathic scoliosis. Orthopade 29:571–577PubMedCrossRef
4.
go back to reference Shen J, Qiu G, Wang Y, Zhang Z, Zhao Y (2006) Comparison of 1-stage versus 2-stage anterior and posterior spinal fusion for severe and rigid idiopathic scoliosis—a randomized prospective study. Spine 31:2525–2528PubMedCrossRef Shen J, Qiu G, Wang Y, Zhang Z, Zhao Y (2006) Comparison of 1-stage versus 2-stage anterior and posterior spinal fusion for severe and rigid idiopathic scoliosis—a randomized prospective study. Spine 31:2525–2528PubMedCrossRef
5.
go back to reference Zhou CG, Liu LM, Song YM, Liu H, Li T, Kong QQ (2011) Anterior and posterior vertebral column resection for severe and rigid idiopathic scoliosis. Eur Spine J 20:1728–1734PubMedCentralPubMedCrossRef Zhou CG, Liu LM, Song YM, Liu H, Li T, Kong QQ (2011) Anterior and posterior vertebral column resection for severe and rigid idiopathic scoliosis. Eur Spine J 20:1728–1734PubMedCentralPubMedCrossRef
6.
go back to reference Toledo LC, Toledo CH, MacEwen GD (1982) Halo traction with the circolectric bed in the treatment of severe spinal deformities: a preliminary report. J Pediatr Orthop 2:554–559PubMedCrossRef Toledo LC, Toledo CH, MacEwen GD (1982) Halo traction with the circolectric bed in the treatment of severe spinal deformities: a preliminary report. J Pediatr Orthop 2:554–559PubMedCrossRef
7.
go back to reference Mehlman CT, Al–Sayyad MJ, Crawford AH (2004) Effectiveness of spinal release and halo-femoral traction in the management of severe spinal deformity. J Pediatr Orthop 24:667–673PubMedCrossRef Mehlman CT, Al–Sayyad MJ, Crawford AH (2004) Effectiveness of spinal release and halo-femoral traction in the management of severe spinal deformity. J Pediatr Orthop 24:667–673PubMedCrossRef
8.
go back to reference Rinella A, Lenke L, Whitaker C, Kim Y, Park SS, Peelle M (2005) Perioperative halo-gravity traction in the treatment of severe scoliosis and kyphosis. Spine 30:475–482PubMedCrossRef Rinella A, Lenke L, Whitaker C, Kim Y, Park SS, Peelle M (2005) Perioperative halo-gravity traction in the treatment of severe scoliosis and kyphosis. Spine 30:475–482PubMedCrossRef
9.
go back to reference Koller H, Zenner J, Gajic V, Meier O, Ferraris L, Hitzl W (2012) The impact of halo-gravity traction on curve rigidity and pulmonary function in the treatment of severe and rigid scoliosis and kyphoscoliosis: a clinical study and narrative review of the literature. Eur Spine J 21:514–529PubMedCentralPubMedCrossRef Koller H, Zenner J, Gajic V, Meier O, Ferraris L, Hitzl W (2012) The impact of halo-gravity traction on curve rigidity and pulmonary function in the treatment of severe and rigid scoliosis and kyphoscoliosis: a clinical study and narrative review of the literature. Eur Spine J 21:514–529PubMedCentralPubMedCrossRef
10.
go back to reference Watanabe K, Lenke LG, Bridwell KH, Kim YJ, Hensley M, Koester L (2010) Efficacy of perioperative halo-gravity traction for treatment of severe scoliosis (O/5100 degrees). J Orthop Sci 15:720–730PubMedCrossRef Watanabe K, Lenke LG, Bridwell KH, Kim YJ, Hensley M, Koester L (2010) Efficacy of perioperative halo-gravity traction for treatment of severe scoliosis (O/5100 degrees). J Orthop Sci 15:720–730PubMedCrossRef
11.
go back to reference Park DK, Braaksma B, Hammerberg KW, Sturm P (2013) The efficacy of preoperative halo-gravity traction in pediatric spinal deformity the effect of traction duration. J Spinal Disord Tech 26:146–154PubMedCrossRef Park DK, Braaksma B, Hammerberg KW, Sturm P (2013) The efficacy of preoperative halo-gravity traction in pediatric spinal deformity the effect of traction duration. J Spinal Disord Tech 26:146–154PubMedCrossRef
12.
go back to reference Bridwell KH (2006) Decision making regarding Smith-Petersen vs. pedicle subtraction osteotomy vs. vertebral column resection for spinal deformity. Spine 31:S171–S178PubMedCrossRef Bridwell KH (2006) Decision making regarding Smith-Petersen vs. pedicle subtraction osteotomy vs. vertebral column resection for spinal deformity. Spine 31:S171–S178PubMedCrossRef
13.
go back to reference Lenke LG, O’ Leary PT, Bridwell KH (2009) Posterior vertebral column resection for severe pediatric deformity: minimum two-year follow-up of thirty-five consecutive patients. Spine 34:2213–2221PubMedCrossRef Lenke LG, O’ Leary PT, Bridwell KH (2009) Posterior vertebral column resection for severe pediatric deformity: minimum two-year follow-up of thirty-five consecutive patients. Spine 34:2213–2221PubMedCrossRef
14.
go back to reference Lenke LG, Sides BA, Koester LA, Hensley M, Blanke KM (2010) Vertebral column resection for the treatment of severe spinal deformity. Clin Orthop Relat Res 468:687–699PubMedCentralPubMedCrossRef Lenke LG, Sides BA, Koester LA, Hensley M, Blanke KM (2010) Vertebral column resection for the treatment of severe spinal deformity. Clin Orthop Relat Res 468:687–699PubMedCentralPubMedCrossRef
15.
go back to reference Smith JS, Wang VY, Ames CP (2008) Vertebral column resection for rigid spinal deformity. Neurosurgery 63:177–182PubMedCrossRef Smith JS, Wang VY, Ames CP (2008) Vertebral column resection for rigid spinal deformity. Neurosurgery 63:177–182PubMedCrossRef
16.
go back to reference Suk SI, Chung ER, Kim JH, Kim SS, Lee JS, Choi WK (2005) Posterior vertebral column resection for severe rigid scoliosis. Spine 30:1682–1687PubMedCrossRef Suk SI, Chung ER, Kim JH, Kim SS, Lee JS, Choi WK (2005) Posterior vertebral column resection for severe rigid scoliosis. Spine 30:1682–1687PubMedCrossRef
17.
go back to reference Hamzaoglu A, Alanay A, Ozturk C, Sarier M, Karadereler S, Ganiyusufoglu K (2011) Posterior vertebral column resection in severe spinal deformities: a total of 102 cases. Spine 36:E340–E344PubMed Hamzaoglu A, Alanay A, Ozturk C, Sarier M, Karadereler S, Ganiyusufoglu K (2011) Posterior vertebral column resection in severe spinal deformities: a total of 102 cases. Spine 36:E340–E344PubMed
18.
go back to reference Lenke LG, Newton PO, Sucato DJ, Shufflebarger HL, Emans JB, Sponseller PD et al (2013) Complications after 147 consecutive vertebral column resections for severe pediatric spinal deformity. Spine 38:119–132PubMedCrossRef Lenke LG, Newton PO, Sucato DJ, Shufflebarger HL, Emans JB, Sponseller PD et al (2013) Complications after 147 consecutive vertebral column resections for severe pediatric spinal deformity. Spine 38:119–132PubMedCrossRef
19.
go back to reference Jeszenszky D, Haschtmann D, Kleinstuck FS, Sutter M, Eggspuhler A, Weiss M et al (2013) Posterior vertebral column resection in early onset spinal deformities. Eur Spine J 23(1):198–208PubMedCrossRef Jeszenszky D, Haschtmann D, Kleinstuck FS, Sutter M, Eggspuhler A, Weiss M et al (2013) Posterior vertebral column resection in early onset spinal deformities. Eur Spine J 23(1):198–208PubMedCrossRef
20.
go back to reference Grass PJ, Soto AV, Araya Hp (1997) Intermittent distracting rod for correction of high neurologic risk congenital scoliosis. Spine (Phila Pa 1976) 22(16):1922–1927CrossRef Grass PJ, Soto AV, Araya Hp (1997) Intermittent distracting rod for correction of high neurologic risk congenital scoliosis. Spine (Phila Pa 1976) 22(16):1922–1927CrossRef
21.
go back to reference Buchowski JM, Bhatnagar R, Skaggs DL, Sponseller PD (2006) Temporary internal distraction asan aid to correction of severe scoliosis. J Bone Joint Surg Am 88:2035–2041PubMedCrossRef Buchowski JM, Bhatnagar R, Skaggs DL, Sponseller PD (2006) Temporary internal distraction asan aid to correction of severe scoliosis. J Bone Joint Surg Am 88:2035–2041PubMedCrossRef
22.
go back to reference Enercan M, Ozturk C, Kahraman S, Sarıer M, Hamzaoglu A, Alanay A (2013) Osteotomies/spinal column resections in adult deformity. Eur Spine J 22(Suppl 2):S254–S264PubMedCrossRef Enercan M, Ozturk C, Kahraman S, Sarıer M, Hamzaoglu A, Alanay A (2013) Osteotomies/spinal column resections in adult deformity. Eur Spine J 22(Suppl 2):S254–S264PubMedCrossRef
23.
go back to reference Sponseller PD, Takenaga RK, Newton P, Boachie O, Flynn J, Letko L (2008) The use of traction in the treatment of severe spinal deformity. Spine 33(21):2305PubMedCrossRef Sponseller PD, Takenaga RK, Newton P, Boachie O, Flynn J, Letko L (2008) The use of traction in the treatment of severe spinal deformity. Spine 33(21):2305PubMedCrossRef
24.
go back to reference MacLennan A (1922) Scoliosis. Br Med J 2:865–866 MacLennan A (1922) Scoliosis. Br Med J 2:865–866
25.
go back to reference Bradford DS, Tribus CB (1997) Vertebral column resection for the treatment of rigid coronal decompensation. Spine 22:1590–1599PubMedCrossRef Bradford DS, Tribus CB (1997) Vertebral column resection for the treatment of rigid coronal decompensation. Spine 22:1590–1599PubMedCrossRef
26.
go back to reference Xie JM, Li T, Wang YS, Zhao Z, Zhang Y, Bi N (2012) Change in Cobb angle of each segment of the major curve after posterior vertebral column resection (PVCR): a preliminary discussion of correction mechanisms of PVCR. Eur Spine J 21:705–710PubMedCentralPubMedCrossRef Xie JM, Li T, Wang YS, Zhao Z, Zhang Y, Bi N (2012) Change in Cobb angle of each segment of the major curve after posterior vertebral column resection (PVCR): a preliminary discussion of correction mechanisms of PVCR. Eur Spine J 21:705–710PubMedCentralPubMedCrossRef
27.
go back to reference Koptan W, EIMiligui Y (2012) Three-staged correction of severe rigid idiopathic scoliosis using limited halo-gravity traction. Eur Spine J 21(6):1091–1098PubMedCentralPubMedCrossRef Koptan W, EIMiligui Y (2012) Three-staged correction of severe rigid idiopathic scoliosis using limited halo-gravity traction. Eur Spine J 21(6):1091–1098PubMedCentralPubMedCrossRef
28.
go back to reference Li C, Fu QS, Zhou Y, Yu HY, Zhao G (2012) Posterior extrapleural intervertebral space release combined with wedge osteotomy for the treatment of severe rigid scoliosis. Spine 37:E647–E654PubMedCrossRef Li C, Fu QS, Zhou Y, Yu HY, Zhao G (2012) Posterior extrapleural intervertebral space release combined with wedge osteotomy for the treatment of severe rigid scoliosis. Spine 37:E647–E654PubMedCrossRef
29.
go back to reference Tan R, Ma HS, Zou DW, Wu JG, Chen ZM, Zhou XF (2012) Surgical treatment of severe scoliosis and kyphoscoliosis by stages. Chin Med J 125(1):81–86PubMed Tan R, Ma HS, Zou DW, Wu JG, Chen ZM, Zhou XF (2012) Surgical treatment of severe scoliosis and kyphoscoliosis by stages. Chin Med J 125(1):81–86PubMed
30.
go back to reference Cheng XF, Ma HS, Tan R, Wu JG, Zhou JW, Zou DW (2012) Two-stage posterior-only procedures for correction of severe spinal deformities. Arch Orthop Trauma Surg 132:193–201PubMedCrossRef Cheng XF, Ma HS, Tan R, Wu JG, Zhou JW, Zou DW (2012) Two-stage posterior-only procedures for correction of severe spinal deformities. Arch Orthop Trauma Surg 132:193–201PubMedCrossRef
Metadata
Title
Comparison of anterior and posterior vertebral column resection versus anterior release with posterior internal distraction for severe and rigid scoliosis
Authors
Chunpeng Ren
Limin Liu
Yueming Song
Chunguang Zhou
Hao Liu
Tao Li
Publication date
01-06-2014
Publisher
Springer Berlin Heidelberg
Published in
European Spine Journal / Issue 6/2014
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-014-3270-6

Other articles of this Issue 6/2014

European Spine Journal 6/2014 Go to the issue