Strong halo-femoral traction with wide posterior spinal release and three dimensional spinal correction for the treatment of severe adolescent idiopathic scoliosis

Background Many investigators advocate anterior release combined with halo-femoral traction and posterior fusion when treating stiff thoracic curves. But the anterior operations often induce many severe complications. So some surgeons choose posterior-only surgery with halo-femoral traction, posterior wide release and correction. But to the best of our knowledge, there are rare prospective study on these posterior-only surgery for AIS patient who has rigid curve more than 80° and flexibility less than 35%.Mothed Sixty four AIS patients were recruited from September 2006 to June 2009. All patients had rigid curves and underwent spinal correction. They were randomly divided to group A (combined anteroposterior surgery) and group B (posterior-only surgery). Images and scoliosis research society-22 questionnaire (SRS-22) scores were performed pre- and post-operation and during follow-up visits. The operation time, blood loss, hospital days , hospital charges were compared between two groups.Result These patients were followed for the average of 37.5 months (range, 24-65 months). No serious complication was observed. There were no statistically significant differences between the two groups in gender, age, preoperative radiographic data or preoperative SRS-22 score. The average operative time, blood loss, hospital days and hospital charges in group B were less than those in group A. The SRS-22 in group B was better than group A at post-operation and final follow-up.Conclution In adolescent idiopathic scoliosis with rigid curve more than 80° and flexibility less than 35%, strong halo-femoral traction with wide posterior spinal release and three dimensional spinal correction can provide better SRS-22 scores, comparable curve correction, shorter operative time, less blood loss, shorter hospital days and less charges when compared to combined anterior and posterior surgery.