Treatment of stiff thoracic scoliosis by thoracoscopic anterior release combined with posterior instrumentation and fusion.

BACKGROUND: Thoracoscopic anterior release has been shown that it can effectively improve spinal flexibility in animal and human cadaveric studies, and has been advocated for use in patients with scoliosis. This prospective case series aims to investigate the improvement of the spinal flexibility and the effectiveness in deformity correction by anterior thoracoscopic release and posterior spinal fusion. METHODS: Eleven patients with stiff idiopathic thoracic scoliosis underwent anterior thoracoscopic release followed by posterior instrumentation. The average number of discs excised was five. Spinal flexibility was assessed by the fulcrum bending technique. Cobb angle before and after the anterior release was compared. RESULTS: The patients were followed for an average of 5.6 years (range 2.2 to 8.1 years). Fulcrum bending flexibility was increased from 39% before the thoracoscopic anterior spinal release to 54% after the release. The average Cobb angle before anterior release was 74 degrees on the standing radiograph and 45 degrees with the fulcrum-bending radiograph. This reduced to 34 degrees on the fulcrum-bending radiograph after the release, and highly corresponded to the 31 degrees measured at the post-operative standing radiograph. CONCLUSION: It was demonstrated in patients with stiff idiopathic thoracic scoliosis that thoracoscopic anterior spinal release can effectively improve the spinal flexibility and increase the correction of the spinal deformity.

[Surgical treatment of kyphosis with universal spine system].

OBJECTIVE: To introduce a method to treat kyphosis with universal spine system (USS) and to evaluate its clinical effect. METHODS: From January 2000 to September 2002, 31 patients with kyphosis were treated with "one-stage total vertebral wedge-shaped osteotomy" and internal fixation of USS. The average follow-up time was 12 months (6-31 months). We observed the clinical effect with the spinal column Cobb before operation and after operation, and the osteotomy confluence rate. RESULTS: In 31 patients, the average angle (Cobb) was 89 degrees before operation and 74 degrees after operation; the average rate of correction was 83.15% and the average rate of osteotomy confluence was 96.77%. No screw and rod broke and loosened. CONCLUSION: The USS is the reliable internal fixation instrument for the treatment of kyphosis, can increase the osteotomy confluence rate and improve correcting rate.