title: Anterior release internal distraction and posterior spinal fusion for severe and rigid scoliosis.
abstract: METHODS
  Retrospective study.
  
  
  OBJECTIVE
  To report on the results of anterior release, posterior internal distraction (with or without further distraction), and subsequent posterior spinal fusion for severe and rigid scoliosis.
  
  
  BACKGROUND
  For severe and rigid scoliosis, conventional procedures, such as posterior instrumentation combined with an anterior release, enable limited correction. Posterior vertebral column resection brings better correction but with a high rate of neurological complications or intraoperative neurological events.
  
  
  METHODS
  A total of 15 patients with severe and rigid scoliosis who underwent anterior release, posterior internal distraction (with or without further distraction), and subsequent posterior spinal fusion were retrospectively reviewed after a minimum follow-up of 2 years. The radiographical parameters were evaluated, and clinical records were reviewed.
  
  
  RESULTS
  The average number of anteriorly removed discs was 4.1. Average posterior fusion length comprised 14.3 vertebrae. Overall, internal distraction corrected the mean Cobb angle by 58.1% (from 105.1° to 44.2°) compared with the initial curve magnitude. The mean preoperative scoliosis of 105.1° was corrected to 27.5° (74.3% correction) at the most recent follow-up. The correction rate of the proximal thoracic and thoracolumbar or lumbar curves was 48.1% and 82.1%, respectively. The preoperative thoracic kyphosis of 62.3° was corrected to 33.8° at the most recent follow-up. The preoperative lumbar lordosis of -66.1° was corrected to -46.3° at the most recent follow-up. The mean preoperative coronal imbalance of 0.8 cm improved to 0.5 cm at the most recent follow-up, and sagittal imbalance of 0.3 cm improved to 0.2 cm. Transient dyspnea occurred in one patient after the initial surgery and subsequently resolved. Two patients complained of concave soft-tissue pain after the first distraction. There were no neurological complications.
  
  
  CONCLUSIONS
  Anterior release, posterior internal distraction, and subsequent posterior spinal fusion provide an effective alternative for severe and rigid scoliosis.
  
  
  METHODS
  4.
authors.affiliation: From the Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, Sichuan, P.R. China.
authors.forename: Chunguang
authors.initials: C
authors.lastname: Zhou
authors.forename: Limin
authors.initials: L
authors.lastname: Liu
authors.forename: Yueming
authors.initials: Y
authors.lastname: Song
authors.forename: Hao
authors.initials: H
authors.lastname: Liu
authors.forename: Tao
authors.initials: T
authors.lastname: Li
authors.forename: Quan
authors.initials: Q
authors.lastname: Gong
authors.forename: Jiancheng
authors.initials: J
authors.lastname: Zeng
authors.forename: Qingquan
authors.initials: Q
authors.lastname: Kong
mesh_terms: D000293:Adolescent; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008141:Lordosis / Q000000981:diagnostic imaging / Q000601:surgery; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D019857:Osteogenesis, Distraction / Q000379:methods*; D011859:Radiography; D012189:Retrospective Studies; D012600:Scoliosis / Q000473:pathology / Q000601:surgery*; D012720:Severity of Illness Index; D013123:Spinal Fusion / Q000379:methods*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult