Comparison of anterior and posterior vertebral column resection versus anterior and posterior spinal fusion for severe and rigid scoliosis

Abstract

Background context: Many different correction methods have been reported to treat severe and rigid scoliosis. In the past, anterior and posterior spinal fusion (APSF), which included an anterior release followed by posterior instrumented fusion, was widely applied. In recent years, anterior/posterior vertebral column resection (APVCR) is used to treat severe and rigid scoliosis.

Purpose: We aimed to compare the clinical results of APSF and APVCR for severe and rigid scoliosis.

Study design: This is a retrospective, one-center, institutional review board-approved study.

Patient sample: A total of 48 patients with severe and rigid scoliosis treated by APSF or APVCR were enrolled.

Outcome measures: Comparisons between groups were made regarding the following variables: age at surgery, gender, etiology, flexibility of main curve, anterior release length, posterior fusion length, screw number, operation time, estimated blood loss, hospitalization time, follow-up duration, different radiological parameters, complication rate, and Scoliosis Research Society (SRS)-22 scores.

Methods: According to the operating technique, 48 patients with severe and rigid scoliosis were divided into two groups. In the first group, 26 patients were treated by APSF. In the second group, 22 patients were treated by APVCR. All patients had a minimum 2-year follow-up. The radiographic parameters as well as anterior release length, posterior fusion length, screw number, operation time, estimated blood loss, hospitalization time, complication rate, and demographic data were analyzed.

Results: There was no significant difference in age, gender, etiology, flexibility of main curve, anterior release length, posterior fusion length, screw number, and follow-up between the two groups. The APVCR group had longer operation and hospitalization time, and more blood loss. There was no significant difference in the preoperative main curve between the two groups, but the APVCR group had smaller main curve at postoperation and final follow-up, and higher correction rate at immediate postoperation and final follow-up. There was no significant difference in the preoperative, postoperative, and final follow-up thoracic kyphosis, and coronal and sagittal balance between the two groups. There was no significant difference in complication rate between the two groups. Analysis of the preoperative SRS-22 questionnaire revealed no difference between the two groups. At final follow-up, APSF and APVCR groups had similar scores in the function, pain, self-image, mental health, and satisfaction with the treatment domains.

Conclusions: Compared with APSF, treating severe and rigid scoliosis by APVCR means longer operation and hospitalization time, and more blood loss, but it allows better correction rate of main curve. Furthermore, SRS-22 questionnaire improvement scores were similar for both correction methods.

Keywords: Anterior and posterior spinal fusion; Anterior and posterior vertebral column resection; Anterior release; Comparison; Severe and rigid scoliosis; Vertebral column resection.