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, 刘洋, 朱晓东, 等. 一期前路松解后路三维矫形治疗重度僵硬性脊柱侧凸. 中华骨科杂志, 2004, 24(5):271-275.
3.	王以朋, 徐宏光, 邱贵兴, 等. 前路松解术在重度青少年特发性脊柱侧凸治疗中的价值. 中华外科杂志, 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, 易国良, 王文军, 等. 改良Halo-骨盆架分期牵引治疗重度僵硬性脊柱侧凸的疗效分析. 中国骨伤, 2011, 24(9):737-741.
11.	杨贵成. 前路松解联合后路矫形固定治疗重度脊柱侧凸. 中国骨伤, 2009, 22(10):781-782.
12.	郑君涛, 于建华, 田慧中. "颅盆环"牵引结合后路矫形术治疗重度特发性脊柱侧凸. 中国矫形外科杂志, 2011, 19(11):955-957.
13.	Elfström 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.	马华松, 周建伟, 邹德威, 等. 极重度脊柱侧凸的二期手术治疗. 脊柱外科杂志, 2007, 5(6):334-337.
16.	马华松, 邹德威, 周建伟, 等. 重度脊柱侧后凸畸形的后路分期手术治疗. 中国脊柱脊髓杂志, 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.	江龙, 朱泽章, 邱勇, 等. 全椎弓根螺钉与钉钩联合系统治疗青少年Chiari畸形伴胸椎侧凸的疗效比较. 中华骨科杂志, 2014, 34(5): 517-524.
19.	李明, 王传锋, 贺石生, 等. 简体中文版脊柱侧凸研究学会22项患者量表的信度和效度. 中国脊柱脊髓杂志, 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, 宋跃明. 重度僵硬性脊柱侧凸矫正技术进展. 中国修复重建外科杂志, 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, 刘洋, 朱晓东, 等. 一期前路松解后路三维矫形治疗重度僵硬性脊柱侧凸. 中华骨科杂志, 2004, 24(5):271-275.
3. 王以朋, 徐宏光, 邱贵兴, 等. 前路松解术在重度青少年特发性脊柱侧凸治疗中的价值. 中华外科杂志, 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, 易国良, 王文军, 等. 改良Halo-骨盆架分期牵引治疗重度僵硬性脊柱侧凸的疗效分析. 中国骨伤, 2011, 24(9):737-741.
11. 杨贵成. 前路松解联合后路矫形固定治疗重度脊柱侧凸. 中国骨伤, 2009, 22(10):781-782.
12. 郑君涛, 于建华, 田慧中. "颅盆环"牵引结合后路矫形术治疗重度特发性脊柱侧凸. 中国矫形外科杂志, 2011, 19(11):955-957.
13. Elfström 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. 马华松, 周建伟, 邹德威, 等. 极重度脊柱侧凸的二期手术治疗. 脊柱外科杂志, 2007, 5(6):334-337.
16. 马华松, 邹德威, 周建伟, 等. 重度脊柱侧后凸畸形的后路分期手术治疗. 中国脊柱脊髓杂志, 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. 江龙, 朱泽章, 邱勇, 等. 全椎弓根螺钉与钉钩联合系统治疗青少年Chiari畸形伴胸椎侧凸的疗效比较. 中华骨科杂志, 2014, 34(5): 517-524.
19. 李明, 王传锋, 贺石生, 等. 简体中文版脊柱侧凸研究学会22项患者量表的信度和效度. 中国脊柱脊髓杂志, 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, 宋跃明. 重度僵硬性脊柱侧凸矫正技术进展. 中国修复重建外科杂志, 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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