[Multiple derotation plus costotransversectomy for severe and rigid scoliosis]

To explore the outcomes of multiple derotation plus costotransversectomy for patients with severe and rigid scoliosis.

Clinical analyses were conducted for the clinical data of operative duration, blood loss volume and SRS-22 scale. Radiographic data included Cobb angle of coronal curves, apical vertebral translation, coronal balance and sagittal balance. All measurements were taken pre-operation, post-operation and during the final follow-up period.

The mean follow-up period was 4.1 ± 0.7 (3-5.5) years, mean operative duration 33 ± 8.4 min and mean blood loss volume 2303.5 ± 9.0 ml. Preoperative major curves ranged from 65° to 110° Cobb angle. Coronal plane correction of major curve from 10° to 41° Cobb angle (mean 30.8 ± 9.8°). And there was a mean loss of correction of 3.6% during the final follow-up. The magnitudes of thoracic kyphosis and lumbar lordosis were 31.1 ± 12.4°, 45.5 ± 10.5° pre-operation, 25.6 ± 5.5°, 33.43 ± 5.45° post-operation and 28.6 ± 6.1°, 35.26 ± 4.2° during the final follow-up. The apical vertebral translation of major curve was corrected by 73.2%. The coronal imbalance, sagittal imbalance and apical vertebral translation indifferently was 3.2 ± 1.1, 2.3 ± 1.1, 6.35 ± 1.65 cm pre-operation, 0.9 ± 1.0, 0.4 ± 0.5, 2.4 ± 1.2 cm post-operation and 1.2 ± 1.1, 0.6 ± 0.5, 2.6 ± 1.4 cm during the final follow-up. Incomplete thoracic nerve dysfuction occurred in one case and superficial dermatoedge necrosis in another recovered within 2 weeks. Neither malposition of pedicle screw nor complication of instrumentation was found. Excellent outcomes were obtained according to SRS-22 score.

For patients with severe and rigid scoliosis, the technique of multi-rod-derotation and rib resection may achieve a good correction of scoliosis without serious complications and avoid a resection of vertebral column.