LONG-TERM RESULTS OF SURGICAL TREATMENT INPATIENTS WITH IDIOPATHIC SCOLIOSIS

Objectives. This study is aimed at assessing the real efficiency of surgery for IS on a long-term basis using three different techniques. A series of 311 patients with IS was operated on (1987–2003) using the instrumentations of Tanchev – Stefanov (TSI) in 286 cases and Cotrel – Dubousset (CDI) in 25 cases. A control group of 50 patients treated with Harrington rods (HI) before 1987 was included for comparative purpose, making a total of 361. To ensure long-term follow-up validity, only the patients operated on till December 31, 1998 (n = 265) were evaluated retrospectively in this study. The implant systems used included HI (n = 50), TSI (n = 190) and CDI (n = 25). Average preoperative coronal angles were 72°, 67° and 79°, respectively. Average follow-up time was 180, 70 and 67 months, respectively. Final clinical and radiological outcomes, bony fusion rate, complication rate, subjective patient appraisal, characteristics of implants applied, effect of thoracoplasty and cost-effectiveness of treatment were assessed.

Results. Final frontal correction obtained was 24.5 % for HI, being significantly lower (p < 0.05) than that in the TSI-group (43 %) and CDI-group (45 %).TSI and CDI revealed statistically equal results (p > 0.05). Sagittal correction was also comparable – 36 % and 34 %, respectively (p > 0.05). Minor derotative effect (4.5°) was found for both instrumenations. Primary bony fusion was achieved in 82 % of HI-group, in 95 % of TSI-group, and in 92 % of CDI-group. Complications were more frequent when using HI (30 %), while the complication rates were lower in TSI-patients (14 %) and CDI (12 %). The subjective patient appraisal of treatment outcome was positive – 82 % for HI, 91 % for TSI, and 92 % for CDI.

Conclusions. TSI and CDI provide equally favourable late results at a lower complication rate as compared to those obtained by using HI.

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