Fusionless Surgery for Scoliosis: 2 to 15 Year Radiographic and Clinical Follow-up

Introduction: Fusionless surgery is the optimum surgical option for scoliosis if it can properly correct the scoliotic deformity. The aim of this study was to analyze the results of fusionless, multiple vertebral wedge osteotomy performed at our institution since 1987.

Materials and Methods: The study sample consisted of 20 patients (17 females and 3 males) with 19 idiopathic and one syringomyelia scoliosis. The average age at surgery was 16.4 years (range 13 to 28). Risser grade was 0 in two patients, I in two, IV in five, and V in 11. Curve type according to King's classification was type II in two patients, III in nine, IV in five, and V in four. The average preoperative curve magnitude was 64.0° (range 52 to 78) by Cobb's method. These patients underwent wedge osteotomies on 3.6 vertebrae in average (range 2 to 5) in the region of T6 to T12. Osteotomies were closed with temporary anterior instrumentation and secured with sutures after removal of the implants. The average follow-up period was 7.8 years (range 2.0 to 15.3).

Results: The average Cobb on the first standing radiograph after surgery was 38.8° (range 19 to 57). The average operation time was 662 minutes (range 430 to 830) and the average estimated blood loss was 1155 ml (range 200 to 2500). There were no neurologic complications. One superficial wound infection necessitated debridement. At one year after surgery, the average Cobb was 42.8° (range 14 to 67). Because of the deterioration of their deformity after surgery, two patients were converted to posterior instrumentation and fusion surgery at 16 and 29 months after the initial procedure respectively. In the remaining 18 patients, correction was maintained as 44.8° (range 14 to 62) at a mean follow-up of 7.8 years.

Conclusion: Fusionless surgery could safely correct the scoliotic deformity.