• Pawel Grabala and Ilkka J Helenius.
• Department of Paediatric Orthopaedics and Traumatology, Medical University of Bialystok, The Faculty of Medicine, Bialystok, Poland. Electronic address: pgrabala@wp.pl.
• World Neurosurg. 2020 Nov 1; 143: e464-e473.

ObjectivesTemporary placement of an internal distraction rod is one of the surgical options in the treatment of severe scoliosis to avoid preoperative halo traction or vertebral column resection. This technique can be applied in a single session or staged. The aim of our study was to report the outcomes of less-invasive temporary internal distraction (LI-TID) in the surgical treatment of adolescents with severe idiopathic scoliosis (IS).MethodsWe performed a single-center, retrospective study of 22 adolescents (19 girls; mean age, 14.8 ± 2.0 years) with severe IS (major curve, ≥90°) who had undergone LI-TID, followed by staged pedicle screw instrumentation, with a minimum of 2 years of follow-up available. The demographic data, radiographic outcomes, pulmonary function test results, perioperative data, revised 22-item Scoliosis Research Society Outcomes questionnaire results, complications, and neuromonitoring data were collected.ResultsThe average major curve was 120° (range, 90°-160°) preoperatively and 59° (range, 29°-69°) at the final follow-up examination. Thoracic kyphosis (T5-T12) had improved from an average of 80° preoperatively to 33° postoperatively (range, 22°-69°), and the spinal height (T1-S1) had increased from 332 mm (range, 198-432 mm) preoperatively to 405 mm (range, 258-495 mm) at the final follow-up visit. Of the 22 patients, 5 (22.7%) had experienced an intraoperative neuromonitoring change without postoperative neurologic deficits, and 2 had developed superior mesenteric artery syndrome, with resolution after conservative treatment. The mean percentage of the predicted forced vital capacity had improved from 44.5% ± 11.3% to 66.5 ± 10.8 at final follow-up (P < 0.05). The total questionnaire score had improved significantly from 2.9 ± 0.61 to 4.1 ± 0.44 (P < 0.05).ConclusionThe results from the present study have shown that staged LI-TID, followed by pedicle screw instrumentation, is safe and effective in adolescents with severe IS, with improvements in spinal deformity, pulmonary function, and health-related quality of life.Copyright © 2020 Elsevier Inc. All rights reserved.

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