Anterior fusion for idiopathic scoliosis

Study Design. A review of the charts and radiographs of 22 patients with id iopathic lumbar, thoracolumbar, and thoracic scoliosis who underwent single -stage anterior fusion with rigid third-generation instrumentation and tita nium surgical mesh implants. Objectives. To validate a new technique for scoliosis correction by assessi ng the initial correction of deformity, trunk shift, and rotation. Perioper ative statistics as well as complications were reviewed. The maintenance of sagittal balance and rate of fusion were also determined after a minimum o f 2 years' follow-up. Summary of Background Data. Posterior correction of scoliosis has been the preferred method of treatment since the introduction of Harrington rods. Re cent advances in instrumentation and surgical techniques have allowed surge ons to approach scoliosis correction through the chest and abdomen. These n ew techniques must be validated before they become accepted alternatives to the standard of care. Methods. One male and 21 female patients, aged 11-18 years, were observed f or an average of 44 months. Matched-pairs t tests were used to compare pre- and postoperative curve measurements. Results. Statistically significant curve improvements were seen when postop erative radiographs were compared with preoperative ones. The instrumented coronal plane curve was corrected 82%. A 65% spontaneous correction of the uninstrumented coronal plane curve was observed. Sagittal kyphosis improved 7 degrees, and apical rotation and tilt angles improved 71% and 80%, respe ctively. A mean loss of 4 degrees of correction was seen on final follow-up radiographs. Lumbar lordosis did not change significantly, and postoperati ve hyperlordosis was not detected. Ninety-six percent of all instrumented l evels fused within 6 months. Although the perioperative complication rate w as low, five patients (23%) had asymptomatic idiopathic retrolisthesis deve lop at the caudal end of the fused vertebrae. Conclusions. Accepted correction of idiopathic scoliosis can be achieved wi th anterior instrumented fusion alone.