IMMEDIATE AND LONG-TERM OUTCOMES OF SURGICAL TREATMENT OF PATIENTS WITH SUPER SEVERE IDIOPATHIC SCOLIOSIS

Objective. To assess possibilities of surgical treatment of patients with super severe (Cobb angle of 120 degrees and more) idiopathic scoliosis.

Material and Methods. Surgical treatment was performed in 15 patients (14 females, 1 male) with idiopathic scoliosis with Cobb angle exceeding 120 degrees. Patients were followed up during 2 years and more. The mean age of patients was 16.1 years. Preoperative examination included plain and functional radiography of the spine, and traction radiography. All patients before and after operation were examined with computer optical topography and answered the SRS questionnaire. A primary method of treatment included correction of spinal deformity with segmental Cotrel-Dubousset instrumentation and posterior fusion with local bone autograft.

Results. The primary curve was reduced from 129.9° to 72.5°(44.2 %). Postoperative progression was 5.9° (10.2 % of the achieved correction). Trunk imbalance was 31.2 mm before surgery, 23.2 mm just after surgery, and 15.5 mm at last follow-up. The tilt of the lowest instrumented vertebra was 26.0° before surgery, 10.7° at two weeks, and 16.7° at long-term follow-up. Thoracic kyphosis was 88.5° at initial examination, 48.1° after surgery, and 59.3° at last follow-up. The mean body height increased by 11 cm. Spirometry test showed mean respiratory volume 1357.1 ml before surgery, and 1690.0 ml at last follow-up.

Conclusion. Surgical treatment of patients with super severe idiopathic scoliosis using modern instrumentation is not only possible but also necessary since it allows for radical changing in shape of the spine and the trunk, normalization of position and functions of interior organs, and improvement of patient’s quality of life.

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