title: Comparison of Thoracoscopic Anterior Release Combined With Posterior Spinal Fusion Versus Posterior-only Approach With an All-pedicle Screw Construct in the Treatment of Rigid Thoracic Adolescent Idiopathic Scoliosis.
abstract: OBJECTIVE
  To compare the effect of thoracoscopic anterior release combined with posterior spinal fusion and posterior-only approach with an all-pedicle screw construct in the treatment of rigid thoracic adolescent idiopathic scoliosis.
  
  
  METHODS
  From June 2001 to June 2010, 63 patients who were admitted to our hospital with thoracic Cobb angle ≥80 degrees and the flexibility ≤40% were enrolled in our study. They were treated with either a combined anterior/posterior spinal fusion with hooks and screws (group A, n=25) or a posterior spinal fusion alone with an all-pedicle screw construct (group B, n=38). The thoracic Cobb angle in the standing whole-spine anteroposterior x-ray, thoracic kyphosis (T5-T12) Cobb angle, imaging examination parameters, fixation segments, implant density, and complications between the 2 groups were compared.
  
  
  RESULTS
  There were no significant differences in operation time, bleeding volume, length of hospital stay, preoperative coronal, sagittal Cobb, coronal curve flexibility, or postoperative coronal Cobb correction ratio between the 2 groups. Moreover, no significant difference in the Scoliosis Research Society-22 score at the last follow-up was present in the 2 groups, although it had been improved compared with that presented during the preoperative period. The implant density of group A (44±4%) was significantly lower than that of group B (55±5%) (P<0.001). In group A, the main complication was chylothorax (n=2) and hemopneumothorax (n=2). In group B, acute intestinal obstruction was observed in 2 patients and pleural effusion was observed in 1 patient. In addition, 12 screws were misplaced (12/403, 3.0%) in group B.
  
  
  CONCLUSIONS
  In patients with rigid thoracic adolescent idiopathic scoliosis, posterior-only approach with an all-pedicle screw construct could achieve the same curve correction as a combined anterior/posterior spinal fusion by increasing the implant density. However, for scoliosis patients with a high risk of implant complications, anterior release combined with posterior spinal fusion is still recommended.
authors.affiliation: *Department of Orthopaedics, Changhai Hospital Affiliated to the Second Medical University, Shanghai †Department of Orthopedics, Kunming General Hospital of Chengdu Military Command, Kunming ‡Department of Orthopedic Injury, General Hospital of Jinan Military Command, Jinan, Shandong Province §Department of Orthopedics, People's Liberation Army 161 Hospital, Wuhan, Hubei Province ∥Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical College ¶Teaching and Research Department of Otorhinolaryngology, The Affiliated Hospital of Xuzhou Medical College, Xuzhou, Jiangsu Province, China.
authors.forename: Zhicai
authors.initials: Z
authors.lastname: Shi
authors.forename: Jiayu
authors.initials: J
authors.lastname: Chen
authors.forename: Chao
authors.initials: C
authors.lastname: Wang
authors.forename: Ming
authors.initials: M
authors.lastname: Li
authors.forename: Quan
authors.initials: Q
authors.lastname: Li
authors.forename: Ye
authors.initials: Y
authors.lastname: Zhang
authors.forename: Cheng
authors.initials: C
authors.lastname: Li
authors.forename: Yuehua
authors.initials: Y
authors.lastname: Qiao
authors.forename: Guo
authors.initials: G
authors.lastname: Kaijin
authors.forename: Chen
authors.initials: C
authors.lastname: Xiangyang
authors.forename: Bo
authors.initials: B
authors.lastname: Ran
mesh_terms: D000293:Adolescent; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D065289:Pedicle Screws; D011300:Preoperative Care; D011859:Radiography; D012189:Retrospective Studies; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D011795:Surveys and Questionnaires; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D013906:Thoracoscopy / Q000379:methods*; D016896:Treatment Outcome