Multiple derotation plus costotransversectomy for severe and rigid scoliosis

Objective: To explore the outcomes of multiple derotation plus costotransversectomy for patients with severe and rigid scoliosis.

Methods: Clinical analyses were conducted for the clinical data of operative duration, blood loss volume and SRS-22 scale. Radiographic data included Cobb angle of coronal curves, apical vertebral translation, coronal balance and sagittal balance. All measurements were taken pre-operation, post-operation and during the final follow-up period.

Results: The mean follow-up period was 4.1 ± 0.7 (3-5.5) years, mean operative duration 33 ± 8.4 min and mean blood loss volume 2303.5 ± 9.0 ml. Preoperative major curves ranged from 65° to 110° Cobb angle. Coronal plane correction of major curve from 10° to 41° Cobb angle (mean 30.8 ± 9.8°). And there was a mean loss of correction of 3.6% during the final follow-up. The magnitudes of thoracic kyphosis and lumbar lordosis were 31.1 ± 12.4°, 45.5 ± 10.5° pre-operation, 25.6 ± 5.5°, 33.43 ± 5.45° post-operation and 28.6 ± 6.1°, 35.26 ± 4.2° during the final follow-up. The apical vertebral translation of major curve was corrected by 73.2%. The coronal imbalance, sagittal imbalance and apical vertebral translation indifferently was 3.2 ± 1.1, 2.3 ± 1.1, 6.35 ± 1.65 cm pre-operation, 0.9 ± 1.0, 0.4 ± 0.5, 2.4 ± 1.2 cm post-operation and 1.2 ± 1.1, 0.6 ± 0.5, 2.6 ± 1.4 cm during the final follow-up. Incomplete thoracic nerve dysfuction occurred in one case and superficial dermatoedge necrosis in another recovered within 2 weeks. Neither malposition of pedicle screw nor complication of instrumentation was found. Excellent outcomes were obtained according to SRS-22 score.

Conclusions: For patients with severe and rigid scoliosis, the technique of multi-rod-derotation and rib resection may achieve a good correction of scoliosis without serious complications and avoid a resection of vertebral column.