title: Surgical treatment of severe congenital scoliosis with unilateral unsegmented bar by concave costovertebral joint release and both-ends wedge osteotomy via posterior approach.
abstract: BACKGROUND
  Congenital scoliosis with unilateral unsegmented bar has remained a surgical challenge. If it is treated with a traditional release of the convex side and an apical wedge osteotomy, there is a risk of bony bridge fracture on the concave side and spine translation during correction maneuvers, which may then result in spinal cord injuries. The authors developed a technique that consists of a concave-side costovertebral joint release followed by both-ends wedge osteotomy via a posterior-only approach. In this article, we describe the technique in detail, and present the results of ten patients treated with this technique.
  
  
  METHODS
  A total of ten patients with congenital scoliosis with unilateral unsegmented bar, who had undergone a concave-side costovertebral joint release followed by both-end wedge osteotomy via a posterior-only approach were followed up for a mean of 34 months (range 26-48 months). The radiographic parameters and clinical records were all reviewed and analyzed.
  
  
  RESULTS
  Body height increased by a mean of 7.3 cm (range 6.0-9.0 cm). The preoperative coronal Cobb angle was 102° (range 83°-139°) with a mean flexibility of 14%. At the most recent follow-up visit, the mean Cobb angle was 35° (range 12°-53°) and the mean correction rate was 66%. The coronal imbalance improved from 3.4 cm (range 0.8-6.3 cm) preoperatively to 1.1 cm (range 0.6-1.8 cm) postoperatively, a 67% correction. There were no definite pseudarthroses, no implant failure, and no obvious loss of correction in the follow-up period. Complications included one patient with hemopneumothorax and another patient with incomplete paralysis of the left lower extremity caused by a pedicle screw violating the spinal canal at the T5 level. The screw was removed 4 h after the initial operation, and the patient fully recovered after 3 months.
  
  
  CONCLUSIONS
  We have had good results with our technique of concave-side costovertebral joint release and both-end wedge osteotomy. It has the advantage of remnant anulus fibrosus, the ligamentum flavum, and the facet joints on the concave side serving both as a hinge and to minimize translation of the spine ends. It can provide excellent three-dimensional curve correction for patients with severe rigid congenital scoliosis with unilateral unsegmented bar.
authors.affiliation: Department of Orthopedic Surgery, Fuyang People's Hospital, Anhui Medical University, No. 63 Luci Street, Fuyang City, 236004, Anhui, China. fylichao2008@sina.com
authors.forename: Chao
authors.initials: C
authors.lastname: Li
authors.forename: Qingsong
authors.initials: Q
authors.lastname: Fu
authors.forename: Yu
authors.initials: Y
authors.lastname: Zhou
authors.forename: Haiyang
authors.initials: H
authors.lastname: Yu
authors.forename: Gang
authors.initials: G
authors.lastname: Zhao
mesh_terms: D000293:Adolescent; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D007596:Joints / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D010027:Osteotomy / Q000295:instrumentation / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D011859:Radiography; D012189:Retrospective Studies; D012272:Ribs / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D012600:Scoliosis / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D012720:Severity of Illness Index; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D055815:Young Adult