The Treatment of Large (>70

· (b – DePuy AcroMed; c – Isole Implants Inc. solely licensed to DePuy AcroMed)

INTRODUCTION: The increasing use of thorascopic techniques in deformity surgery has led several authors to advocate anterior release followed by posterior instrumentation when treating “stiff” thoracic curves of 60° to 70°. This study was undertaken to examine our results in these large curves utilizing posterior surgery alone.

MATERIALS AND METHODS: This is a retrospective review of patients 20 years and younger with idiopathic scoliosis and thoracic curves greater than 70° treated with isolated posterior instrumentation and arthrodesis at two institutions from 1989 to 1999. 42 patients were identified and 38 were available for minimum two year follow-up. 34 of 38 patients had bend films taken prior to surgery. All patients were treated with third generation segmental spinal instrumentation utilizing a varied combination of hooks, wires and screws.

RESULTS: The average age at surgery was 14.5 years (10.7-20 yrs) and the average follow-up was 4.1 years (2-11.5 yrs). The average preoperative thoracic curve was 75° (70-88°) and the average bend was 49° (30-60°). The average postoperative curve was 28° (12-46°) and it was 29° (11-48°) at latest follow-up. The average length of surgery was 5.3 hrs, mean hospital stay was 8 days, and average blood loss was one liter. SRS 22 was available at minimum two years in 31 of 38 patients. Mean domain scores were as follows: Pain- 4.25, Self Image- 4.15, Function- 4.18, Mental Health- 4.12, Satisfaction- 4.52, and Total- 4.24. Complications included one pseudarthrosis and one implant removal for late operative site pain.

DISCUSSION: As the morbidity of anterior release has decreased with the utilization of thorascopic techniques, the indications for using anterior surgery in conjunction with posterior instrumentation and arthrodesis appear to have relaxed. Utilizing isolated posterior surgery, we have been able to at least equal the results reported in the literature by authors using combined approaches. Isolated posterior instrumentation and arthrodesis achieves satisfactory radiographic and patient based outcomes in adolescents with idiopathic scoliosis with thoracic curves of 85° and less without the added expense and morbidity of anterior release.

· If noted, the author indicates something of value received. The codes are identified as: a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options.