SA Orthopaedic Journal
On-line version ISSN 2309-8309
STUDY DESIGN: A retrospective review of adolescent patients undergoing instrumented anterior spinal fusion (ASF) by a single surgeon for thoracolumbar or lumbar (TL/L) scoliosis. OBJECTIVE: The aim of this study is to investigate the efficacy and associated morbidity of anterior instrumented corrective fusion for thoracolumbar and lumbar scoliosis. MATERIALS AND METHODS: The medical records and radiographs of 36 consecutively managed patients who underwent anterior spine surgery for thoracolumbar or lumbar curves by a single surgeon between 2001 and 2011 were retrospectively reviewed. The cohort consisted of 26 female and 10 male patients with idiopathic scoliosis as the commonest aetiology. Data collated and analysed included patient demographics, surgical factors, post-operative management and complications. In addition, radiographic analysis was performed on pre-operative and follow-up X-rays, and Scoliosis Research Society (SRS 22) scores were collated. RESULTS: Thoracolumbar/lumbar curves were corrected from 68.4°±18.8° (34°-120°) to 25.9°±16.6° (7°-66°) (average of 62.1% correction). The thoracic compensatory curve spontaneously corrected from 32.8°±14.0° (12°-53°) to 18.4°±14.2° (4°-440) (average of 43.9% correction). Sagittal imbalance of greater than 4 cm was found in 40% of patients pre-operatively and in 16% post-operatively (85% negative sagittal imbalance, 15% positive sagittal imbalance). Rotation according to the Nash-Moe method corrected by 1.2 of a grade (2.37±0.69-1.17±0.58). Average operative time was 194 minutes and estimated blood loss was 460 ml. The diaphragm was taken down in 34 of the 36 patients but no patients required post-op ventilation. The average high care stay was 1.2 days. Average follow-up was 16.9 months. Good maintenance of correction was shown at most recent follow-up, with the mean thoracolumbar/lumbar curve measuring 27.9°±16.7°, and the mean compensatory thoracic curve measuring 20.9°±16.3°. There were no significant neurological or respiratory complications, and no cases had radiological signs of pseudoarthrosis. Scoliosis Research Society scores were obtained in 75% of the idiopathic scoliosis group (18/24), and improved from 75.91 pre-operatively to 84.72 post-operatively. A total of 93.8% were satisfied/very satisfied with their treatment, and 87.5% would probably/definitely have the same treatment again. CONCLUSION: Anterior corrective fusion for thoracolumbar and lumbar scoliosis is effective in both deformity correction and the maintenance thereof. Spontaneous correction of the thoracic curve can be expected and thus limit the fusion to the lumbar curve. Despite the concerns of taking down the diaphragm, there is minimal morbidity. LEVEL OF EVIDENCE: Level IV.
Keywords : anterior instrumented fusion; surgical correction; thoracolumbar/lumbar scoliosis; efficacy and morbidity; Scoliosis Research Society (SRS 22).