[Spinal wedge osteotomy by posterior approach for correction of severe rigid scoliosis]

To introduce operation skill of the spinal wedge osteotomy by posterior approach for correction of severe rigid scoliosis and to discuss the selection of the indications and the range of fusion and fixation.

Between July 1999 and January 2009, 23 patients with severe rigid scoliosis were treated with spinal wedge osteotomy by posterior approach, including 16 congenital scoliosis, 5 idiopathic scoliosis, and 2 neurofibromatosis scoliosis. There were 11 males and 12 females with a median age of 15 years (range, 8-29 years). Two patients had previous surgery history. The Cobb's angles of scoliosis and kyphosis before operation were (85.39 +/- 13.51) degrees and (56.78 +/- 17.69) degrees, respectively. The mean spinal flexibility was 14.4% (range, 4.7%-22.5%). The trunk shift was (15.61 +/- 4.89) mm. The preoperative CT or MRI showed bony septum in the canal in 2 patients.

The mean operative time was 241 minutes and the mean blood loss was 1 452 mL. The average fused vertebrae were 10.7 segments (range, 8-14 segments). The follow-up ranged from 1 to 4 years with an average of 2 years and 6 months. The postoperative Cobb's angle of scoliosis was (38.70 +/- 6.51) degrees, the average correction rate was 54.7%. The postoperative Cobb's angle of kyphosis was (27.78 +/- 6.01) degrees, the average correction rate was 51.0%. The trunk shift was improved to (4.69 +/- 1.87) mm, the increased height was 5.2 cm on average (range, 2.8-7.7 cm). The Cobb's angle of scoliosis was (41.57 +/- 6.80) degrees with an average 2.9 degrees loss of correction at the final follow-up; the Cobb's angle of kyphosis was (30.39 +/- 5.94) degrees with an average 2.6 degrees loss of correction at the final follow-up; the trunk shift was (4.78 +/- 2.00) mm at the final follow-up. There were significant differences (P < 0.05) in the Cobb's angles of scoliosis and kyphosis and the trunk shift between preoperation and postoperation, between preoperation and last follow-up. Four cases had pedicle fracture, 1 had Li nerve root injury, 2 had superior mesenteric artery syndrome, 1 had exudates of incision, and 2 had temporary dysfunction of both lower extremity.

Spinal wedge osteotomy by posterior approach is a reliable and safe surgical technique for correcting severe rigid scoliosis. With segmental pedical screw fixation, both the spinal balance and stability can be restored.