title: Posterior extrapleural intervertebral space release combined with wedge osteotomy for the treatment of severe rigid scoliosis.
abstract: METHODS
  Retrospective clinical case series.
  
  
  OBJECTIVE
  To report the technique and results of posterior extrapleural intervertebral space release (PEISR) combined with wedge osteotomy (WO) for the treatment of severe rigid scoliosis.
  
  
  BACKGROUND
  Conventional surgical correction techniques for severe rigid scoliosis include anterior release combined with posterior instrumentation and fusion and vertebral column resection.
  
  
  METHODS
  Between 2004 and 2009, 18 patients underwent PEISR and WO at a single institution. The indications were scoliosis with coronal Cobb's angle greater than 90° and curve flexibility less than 25%. The median age at surgery was 18.1 years (range, 13-26 yr). Nine patients had a preoperative forced vital capacity that was less than 40% of predicted. All patients had a minimum 2-year radiographical and clinical follow-up (range, 2.0-5.7 yr).
  
  
  RESULTS
  A mean of 4.2 discs were excised per patient (range, 2-6 discs) along with a mean of 1.2 vertebrae removed in the osteotomy. Mean number of vertebrae fused was 13.8 (range, 10-16 vertebrae). Mean operating time was 8.8 hours (range, 6.2-12.6 hr), with a mean blood loss of 3990 mL (range, 2600-6100 mL). The mean preoperative Cobb angle of 108.5° (range, 92°-136°) was corrected to 30° at the most recent follow-up (72.4% correction rate). Preoperative thoracic kyphosis of 52° (range, 5°-115°) was corrected to 26° (range, 17°-52°). The mean preoperative coronal imbalance of 3.5 cm was corrected to 0.6 cm (83.8% correction) and the sagittal imbalance of 2.8 cm was corrected to 0.3 cm (90.3% correction). There were no neurological complications. There were no instances of infection or muscle necrosis. Hemopneumothorax occurred in 2 patients.
  
  
  CONCLUSIONS
  PEISR, combined with WO, through a single posterior approach is a technically challenging but safe and effective procedure for severe rigid scoliosis. This posterior-only approach allows for dramatic radiographical correction that surpasses that reported for posterior VCR.
authors.affiliation: Department of Orthopedic Surgery, Fuyang People's Hospital, Anhui Medical University, Fuyang city, Anhui Province, 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; D000328:Adult; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D010027:Osteotomy / Q000379:methods*; D012189:Retrospective Studies; D012600:Scoliosis / Q000473:pathology / Q000601:surgery*; D013131:Spine / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult