[Severe idiopathic scoliosis. Does the approach and the instruments used modify the results?].
OBJECTIVE
The aim of this work is to evaluate and compare the radiographic results and complications of the surgical treatment of adolescents with idiopathic scoliosis greater than 75 degrees, using a double approach (DA) or an isolated posterior approach with hybrid instruments (posterior hybrid [PH]), or with «all-pedicle screws» (posterior screws [PS]).


METHODS
A retrospective review was performed on 69 patients with idiopathic scoliosis greater than 75°, with a follow-up of more than 2 years, to analyze the flexibility of the curves, the correction obtained, and the complications depending on the type of surgery. The Kruskal-Wallis test for non-parametric variables was used for the statistical analysis.


RESULTS
There were no statistically significant differences between the 3 patient groups in the pre-surgical Cobb angle values (DA=89°, PH=83°, PS=83°), in the immediate post-surgical (DA=34°, PH=33°, PS=30°), nor at the end of follow-up (DA=36°, PH=36°, PS=33°) (P>.05). The percentage correction (DA=60%, PH=57%, PS=60%) was similar between groups (P>.05). The percentage of complications associated with the procedure was 20.8% in DA, 10% in PH and 20% in PS. Two patients in the PS group showed changes, with no neurological lesions, in the spinal cord monitoring, and one patient in the same group suffered a delayed and transient incomplete lesion.


CONCLUSIONS
No significant differences were observed in the correction of severe idiopathic scoliosis between patients operated using the double or isolated posterior approach, regardless of the type of instrumentation used.
Unidad de Raquis, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario La Paz, Madrid, España. Electronic address: jm.sanchez.marquez@gmail.com.
J M
JM
Sánchez-Márquez
Unidad de Raquis, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario La Paz, Madrid, España.
F J
FJ
Sánchez Pérez-Grueso
Unidad de Raquis, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario La Paz, Madrid, España.
M
M
Pérez Martín-Buitrago
Unidad de Raquis, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario La Paz, Madrid, España.
N
N
Fernández-Baíllo
Unidad de Raquis, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario La Paz, Madrid, España.
A
A
García-Fernández
Unidad de Raquis, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario La Paz, Madrid, España.
J
J
Quintáns-Rodríguez
D000293:Adolescent; D006801:Humans; D019637:Orthopedic Procedures / Q000295:instrumentation / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology; D011859:Radiography; D012189:Retrospective Studies; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000601:surgery*; D012720:Severity of Illness Index; D016896:Treatment Outcome
Adolescent idiopathic scoliosis; Anterior release; Escoliosis idiopática del adolescente; Hybrid instrumentation; Instrumentación híbrida; Liberación anterior; Thoracic pedicle screws; Tornillos pediculares torácicos