MEDIUM-TERM EFFECTIVENESS OF ANTERIOR RELEASE INTERNAL DISTRACTION FOR SEVERE AND RIGID SCOLIOSIS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LINGTingxian ,  LIULimin , SONGYueming , ZHOUChunguang , YANGXi , HUXingxin , QIANGZhe , ZHOUBangjian

Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China;

Corresponding?author：

LIULimin, Email: 18980601394@163.com

Keywords：

Severe and rigid scoliosis; Anterior release; Internal distraction; Posterior fusion; Health-related quality of life

DOI：

10.7507/1002-1892.20150237

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Objective To observe the medium-term clinical and radiological outcomes of anterior release internal distraction in treatment of severe and rigid scoliosis. Methods Between March 2009 and March 2012, 26 patients with severe and rigid scoliosis were treated with anterior release, posterior internal distraction, and two stage posterior spinal fusion. There were 11 males and 15 females with an average age of 19.6 years (range, 14-25 years). The average disease duration was 13.6 years (range, 3-24 years). All cases were idiopathic scoliosis. Of 26 cases, 2 cases were rated as Lenke type I, 8 as type Ⅱ, 13 as type IV, 1 as type V, and 2 as type VI. The apical vertebrae located at T₆ in 1 case, at T₇ in 3 cases, at T₈ in 7 cases, at T₉ in 13 cases, and at T₁₀ in 2 cases. The average 4 vertebral bodies were released by anterior approach, and average 14 vertebral bodies were fused after posterior surgery. Fourteen patients received 2 times distraction. Scoliosis Research Society-22 (SRS-22) questionnaire was used to access health-related quality of life. The radiological parameters were measured, including coronal plane Cobb angel of major curve, apical vertebral translation (AVT), C₇ plumb line-center sacral vertical line (C₇PL-CSVL), sagittal vertical axis (SVA), and thoracic kyphosis (TK) at pre-and post-operation. Results The average total operation time was 592.7 minutes; the average total blood loss volume was 1 311.2 mL; and total hospitalization cost was (14.7±1.4)×10⁴ yuan RMB. The coronal plane Cobb angle of major curve was (55.7±16.5)°, and the TK was (43.2±16.2)° after first distraction. The patients were followed up 2-5 years (mean, 3.8 years). Temporary dyspnea and pleural effusion occurred in 1 case respectively after distraction, and symptoms disappeared after symptomatic treatment. Screw loosening and pseudoarthrosis formation was observed in 1 case at 6 months after fusion, good recovery was achieved after revision. No infection or neurological complication was found. The coronal plane Cobb angel of major curve, TK, and AVT after fusion and at last follow-up were significantly lower than preoperative ones (P<0.05), but no significant difference was found between at post-fusion and last follow-up (P>0.05). There was no significant difference in C₇PL-CSVL and SVA between at pre-and post-operation (P>0.05). At last follow-up, SRS-22 questionnaire scores were 4.32±0.42 for active degree, 4.54±0.58 for mental health, 3.97±0.76 for self-image, 4.09±0.64 for pain, and 4.03±0.83 for satisfaction degree. Conclusion Anterior release internal distraction can provide satisfactory correction results for severe and rigid scoliosis with higher safety and lower incidence of complication.

Citation： LINGTingxian, LIULimin, SONGYueming, ZHOUChunguang, YANGXi, HUXingxin, QIANGZhe, ZHOUBangjian. MEDIUM-TERM EFFECTIVENESS OF ANTERIOR RELEASE INTERNAL DISTRACTION FOR SEVERE AND RIGID SCOLIOSIS. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(9): 1092-1098. doi: 10.7507/1002-1892.20150237 Copy

1.	Janus GJ, Finidori G, Engelbert RH, et al. Operative treatment of severe scoliosis in osteogenesis imperfecta:results of 20 patients after halo traction and posterior spondylodesis with instrumentation. Eur Spine J, 2000, 9(6):486-491.
2.	李明, 劉洋, 朱曉東, 等. 一期前路松解后路三維矯形治療重度僵硬性脊柱側凸. 中華骨科雜志, 2004, 24(5):271-275.
3.	王以朋, 徐宏光, 邱貴興, 等. 前路松解術在重度青少年特發性脊柱側凸治療中的價值. 中華外科雜志, 2004, 42(2):77-80.
4.	Bullmann V, Halm HF, Schulte T, et al. Combined anterior and posterior instrumentation in severe and rigid idiopathic scoliosis. Eur Spine J, 2006, 15(4):440-448.
5.	Dobbs MB, Lenke LG, Kim YJ, et al. Anterior/posterior spinal instrumentation versus posterior instrumentation alone for the treatment of adolescent idiopathic scoliotic curves more than 90 degrees. Spine (Phila Pa 1976), 2006, 31(20):2386-2391.
6.	Qiu Y, Liu Z, Zhu F, et al. Comparison of effectiveness of Halofemoral traction after anterior spinal release in severe idiopathic and congenital scoliosis:a retrospective study. J Orthop Surg Res, 2007, 2: 23.
7.	Shen J, Qiu G, Wang Y, et al. Comparison of 1-stage versus 2-stage anterior and posterior spinal fusion for severe and rigid idiopathic scoliosis-a randomized prospective study. Spine (Phila Pa 1976), 2006, 31(22):2525-2528.
8.	Suk SI, Chung ER, Kim JH, et al. Posterior vertebral column resection for severe rigid scoliosis. Spine (Phila Pa 1976), 2005, 30(14):1682-1687.
9.	Tokunaga M, Minami S, Kitahara H, et al. Vertebral decancellation for severe scoliosis. Spine (Phila Pa 1976), 2000, 25(4):469-474.
10.	宋西正, 易國良, 王文軍, 等. 改良Halo-骨盆架分期牽引治療重度僵硬性脊柱側凸的療效分析. 中國骨傷, 2011, 24(9):737-741.
11.	楊貴成. 前路松解聯合后路矯形固定治療重度脊柱側凸. 中國骨傷, 2009, 22(10):781-782.
12.	鄭君濤, 于建華, 田慧中. "顱盆環"牽引結合后路矯形術治療重度特發性脊柱側凸. 中國矯形外科雜志, 2011, 19(11):955-957.
13.	Elfstr?m G, Nachemson A. Telemetry recordings of forces in the Harrington distraction rod:a method for increasing safety in the operative treatment of scoliosis patients. Clin Orthop Relat Res, 1973, (93):158-172.
14.	Buchowski JM, Bhatnagar R, Skaggs DL, et al. Temporary internal distraction as an aid to correction of severe scoliosis. J Bone Joint Surg (Am), 2006, 88(9):2035-2041.
15.	馬華松, 周建偉, 鄒德威, 等. 極重度脊柱側凸的二期手術治療. 脊柱外科雜志, 2007, 5(6):334-337.
16.	馬華松, 鄒德威, 周建偉, 等. 重度脊柱側后凸畸形的后路分期手術治療. 中國脊柱脊髓雜志, 2009, 19(8):588-592.
17.	Zhou C, Liu L, Song Y, et al. Anterior release internal distraction and posterior spinal fusion for severe and rigid scoliosis. Spine (Phila Pa 1976), 2013, 38(22):E1411-1417.
18.	江龍, 朱澤章, 邱勇, 等. 全椎弓根螺釘與釘鉤聯合系統治療青少年Chiari畸形伴胸椎側凸的療效比較. 中華骨科雜志, 2014, 34(5): 517-524.
19.	李明, 王傳鋒, 賀石生, 等. 簡體中文版脊柱側凸研究學會22項患者量表的信度和效度. 中國脊柱脊髓雜志, 2008, 18(3):212-217.
20.	Greiner KA. Adolescent idiopathic scoliosis:radiologic decisionmaking. Am Fam Physician, 2002, 65(9):1817-1822.
21.	周春光, 宋躍明. 重度僵硬性脊柱側凸矯正技術進展. 中國修復重建外科雜志, 2012, 26(2):238-243.
22.	Li M, Ni J, Li Y, et al. Single-staged anterior and posterior spinal fusion: a safe and effective alternative for severe and rigid adolescent idiopathic scoliosis in China. J Paediatr Child Health, 2009, 45(5):246-253.
23.	Zhou C, Liu L, Song Y, et al. Anterior and posterior vertebral column resection for severe and rigid idiopathic scoliosis. Eur Spine J, 2011, 20(10):1728-1734.
24.	Sponseller PD, Takenaga RK, Newton P, et al. The use of traction in the treatment of severe spinal deformity. Spine (Phila Pa 1976), 2008, 33(21):2305-2309.

1. Janus GJ, Finidori G, Engelbert RH, et al. Operative treatment of severe scoliosis in osteogenesis imperfecta:results of 20 patients after halo traction and posterior spondylodesis with instrumentation. Eur Spine J, 2000, 9(6):486-491.
2. 李明, 劉洋, 朱曉東, 等. 一期前路松解后路三維矯形治療重度僵硬性脊柱側凸. 中華骨科雜志, 2004, 24(5):271-275.
3. 王以朋, 徐宏光, 邱貴興, 等. 前路松解術在重度青少年特發性脊柱側凸治療中的價值. 中華外科雜志, 2004, 42(2):77-80.
4. Bullmann V, Halm HF, Schulte T, et al. Combined anterior and posterior instrumentation in severe and rigid idiopathic scoliosis. Eur Spine J, 2006, 15(4):440-448.
5. Dobbs MB, Lenke LG, Kim YJ, et al. Anterior/posterior spinal instrumentation versus posterior instrumentation alone for the treatment of adolescent idiopathic scoliotic curves more than 90 degrees. Spine (Phila Pa 1976), 2006, 31(20):2386-2391.
6. Qiu Y, Liu Z, Zhu F, et al. Comparison of effectiveness of Halofemoral traction after anterior spinal release in severe idiopathic and congenital scoliosis:a retrospective study. J Orthop Surg Res, 2007, 2: 23.
7. Shen J, Qiu G, Wang Y, et al. Comparison of 1-stage versus 2-stage anterior and posterior spinal fusion for severe and rigid idiopathic scoliosis-a randomized prospective study. Spine (Phila Pa 1976), 2006, 31(22):2525-2528.
8. Suk SI, Chung ER, Kim JH, et al. Posterior vertebral column resection for severe rigid scoliosis. Spine (Phila Pa 1976), 2005, 30(14):1682-1687.
9. Tokunaga M, Minami S, Kitahara H, et al. Vertebral decancellation for severe scoliosis. Spine (Phila Pa 1976), 2000, 25(4):469-474.
10. 宋西正, 易國良, 王文軍, 等. 改良Halo-骨盆架分期牽引治療重度僵硬性脊柱側凸的療效分析. 中國骨傷, 2011, 24(9):737-741.
11. 楊貴成. 前路松解聯合后路矯形固定治療重度脊柱側凸. 中國骨傷, 2009, 22(10):781-782.
12. 鄭君濤, 于建華, 田慧中. "顱盆環"牽引結合后路矯形術治療重度特發性脊柱側凸. 中國矯形外科雜志, 2011, 19(11):955-957.
13. Elfstr?m G, Nachemson A. Telemetry recordings of forces in the Harrington distraction rod:a method for increasing safety in the operative treatment of scoliosis patients. Clin Orthop Relat Res, 1973, (93):158-172.
14. Buchowski JM, Bhatnagar R, Skaggs DL, et al. Temporary internal distraction as an aid to correction of severe scoliosis. J Bone Joint Surg (Am), 2006, 88(9):2035-2041.
15. 馬華松, 周建偉, 鄒德威, 等. 極重度脊柱側凸的二期手術治療. 脊柱外科雜志, 2007, 5(6):334-337.
16. 馬華松, 鄒德威, 周建偉, 等. 重度脊柱側后凸畸形的后路分期手術治療. 中國脊柱脊髓雜志, 2009, 19(8):588-592.
17. Zhou C, Liu L, Song Y, et al. Anterior release internal distraction and posterior spinal fusion for severe and rigid scoliosis. Spine (Phila Pa 1976), 2013, 38(22):E1411-1417.
18. 江龍, 朱澤章, 邱勇, 等. 全椎弓根螺釘與釘鉤聯合系統治療青少年Chiari畸形伴胸椎側凸的療效比較. 中華骨科雜志, 2014, 34(5): 517-524.
19. 李明, 王傳鋒, 賀石生, 等. 簡體中文版脊柱側凸研究學會22項患者量表的信度和效度. 中國脊柱脊髓雜志, 2008, 18(3):212-217.
20. Greiner KA. Adolescent idiopathic scoliosis:radiologic decisionmaking. Am Fam Physician, 2002, 65(9):1817-1822.
21. 周春光, 宋躍明. 重度僵硬性脊柱側凸矯正技術進展. 中國修復重建外科雜志, 2012, 26(2):238-243.
22. Li M, Ni J, Li Y, et al. Single-staged anterior and posterior spinal fusion: a safe and effective alternative for severe and rigid adolescent idiopathic scoliosis in China. J Paediatr Child Health, 2009, 45(5):246-253.
23. Zhou C, Liu L, Song Y, et al. Anterior and posterior vertebral column resection for severe and rigid idiopathic scoliosis. Eur Spine J, 2011, 20(10):1728-1734.
24. Sponseller PD, Takenaga RK, Newton P, et al. The use of traction in the treatment of severe spinal deformity. Spine (Phila Pa 1976), 2008, 33(21):2305-2309.

Chinese Journal of Reparative and Reconstructive Surgery

MEDIUM-TERM EFFECTIVENESS OF ANTERIOR RELEASE INTERNAL DISTRACTION FOR SEVERE AND RIGID SCOLIOSIS

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