title: Retrospective study of two-stage surgery in the treatment of scoliosis exceeding 100 degrees - assessment including spinal balance evaluation.
abstract: BACKGROUND
  Scoliosis 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.
  
  
  METHODS
  Twelve 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.
  
  
  RESULTS
  Mean 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.
  
  
  CONCLUSIONS
  Two-stage treatment of very severe scoliosis enables stable correction with some improvement of spinal balance in both the coronal and sagittal plane.
authors.affiliation: Jagiellonian University, Collegium Medicum, Department of Orthopaedics and Rehabilitation, Zakopany. basiaj@klinika.net.pl
authors.forename: Barbara
authors.initials: B
authors.lastname: Jasiewicz
authors.forename: Tomasz
authors.initials: T
authors.lastname: Potaczek
authors.forename: Andrzej
authors.initials: A
authors.lastname: Szcześniak
authors.forename: Maciej
authors.initials: M
authors.lastname: Tesiorowski
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D016268:Internal Fixators; D007738:Kyphosis / Q000601:surgery; D008141:Lordosis / Q000601:surgery; D008297:Male; D011044:Poland; D004856:Postural Balance; D011859:Radiography; D012189:Retrospective Studies; D012600:Scoliosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D012720:Severity of Illness Index; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013905:Thoracoplasty / Q000379:methods; D014143:Traction / Q000295:instrumentation / Q000379:methods*; D055815:Young Adult