• Barbara Jasiewicz, Tomasz Potaczek, Andrzej Szcześniak, and Maciej Tesiorowski.
• Jagiellonian University, Collegium Medicum, Department of Orthopaedics and Rehabilitation, Zakopany. basiaj@klinika.net.pl
• Ortop Traumatol Rehabil. 2009 Nov 1;11(6):495-500.

BackgroundScoliosis exceeding 100 degrees remains an important problem in spinal orthopaedics. The choice of an optimal surgical technique is crucial, not only because of the degree of correction needed, but also because of the need to minimize the number of complications and avoid imbalance after surgery. The aim of this work is to analyse the outcomes of a two-stage surgical regimen for scoliosis exceeding 100 degrees consisting of anterior release, cranio-femoral traction, and posterior fusion with derotational instrumentation.Material And MethodsTwelve patients with thoracic scoliosis (7 females and 5 males) were assessed retrospectively. The mean curve angle before surgery was 129 degrees. All patients underwent a two-stage procedure consisting of anterior release followed by 10-14 days of cranio-femoral traction and posterior fusion with derotational instrumentation. Mean age at surgery was 19 years. The mean follow-up period was 5 years. Radiological evaluation was based on postero-anterior and lateral radiographs.ResultsMean curve correction was 44% and this result was stable during the follow-up period. Thoracic kyphosis did not change significantly after treatment, remaining at 61 degrees on average. Coronal decompensation was noted in 4 patients before surgery and one of the four after treatment. The Th1-midline distance improved significantly, as did the Th12-L2 angle on lateral radiographs. There were no neurological complications.ConclusionTwo-stage treatment of very severe scoliosis enables stable correction with some improvement of spinal balance in both the coronal and sagittal plane.

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