ABSTRACT
Objective:To analyze the efficacy of posterior staged correction in the treatment of severe kyphoscoliosis.Methods:Retrospective analysis was conducted on 61 patients with severe kyphoscoliosis who underwent one-stage posterior Ponte osteotomy followed by Halo-femoral traction and two-stage posterior correction in Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School between January 2010 and January 2020. There were 23 males and 38 females with an average age of 22.0(18.0, 25.5) years. The etiologies were idiopathic in 26 cases, congenital in 17 cases, neuromuscular in 16 cases and Marfan syndrome with kyphoscoliosis in 2 cases. The curves were thoracic in 49 cases, thoracolumbar in 3 cases and double major in 9 cases. The apical vertebrae were T 5 level in 1 case, T 7 level in 2 cases, T 8 level in 9 cases, T 9 level in 15 cases, T 10 level in 23 cases, T 11 level in 8 cases, T 12 level in 1 case, and L 1 level in 2 cases. The flexibility of main curve was 13.5%±8.6%. The Cobb angle of main curve, global kyphosis (GK), coronal trunk shift (CTS), sagittal vertical axis (SVA), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS) were assessed at pre-operation, post-traction, post-operation and the last follow-up. The quality of life was evaluated using the MOS item short form health survey (SF)-36 questionnaire, and the complications during peri-operation and long-term follow-up were recorded. Results:All 61 patients were followed up for 25.0 (24.0, 26.5) months. The Cobb angle of main curve and GK were 121.4°±13.9° and 86.8°±20.0° at pre-operation, 94.1°±18.7° and 66.9°±15.3° at post-traction, 78.5°±20.3° and 54.7°±13.6° at post-operation and 79.5°±20.1° and 53.2°±11.3° at the last follow-up, respectively. The differences were statistically significant ( F=210.54, P<0.001; F=93.74, P<0.001). There was no significant difference between the last follow-up and post-operation ( P>0.05). There was no significant correction loss of SVA, TK, LL, PI, PT or SS at the last follow-up when compared with those at post-operation ( P>0.05). The CTS was 17.1±9.8 mm at pre-operation, 17.5±11.4 mm at post-operation, 11.1 (5.9, 23.3) mm at the last follow-up and the difference was statistically significant (χ 2=6.70, P=0.035). The difference between the last follow-up and post-operation was statistically significant ( P=0.032). The scores of physical functioning 80.0 (75.0, 85.0), general health 82.0 (69.5, 87.0) and social functioning 75.0 (62.5, 75.0) in SF-36 at the last follow-up were significantly improved compared with those at pre-operation ( Z=-2.11, P=0.035; Z=-3.64, P<0.001; Z=-2.07, P=0.039). During the traction process, the complications included pin track infection in 1 case, deep vein thrombosis of the lower extremity in 2, misplacement of pedicle screws in 3, coronal decompensation at immediate post-operation in 2, sagittal decompensation at immediate post-operation in 1, and 1 patient had broken rod at 3 years follow-up, respectively. Conclusion:The posterior staged correction could provide satisfying radiographic and clinical outcomes in patients with severe kyphoscoliosis, which could be well maintained during 2 years follow-up. Therefore, the posterior staged correction is a safe and effective treatment for severe kyphoscoliosis.