Different treatment modalities and their impact on outcomes in severe rigid scoliosis: a systematic review and pooled...

Severe rigid scoliosis is a stiff and complex three-dimensional deformity. The children presenting with severe scoliosis need to be timely treated to prevent further deterioration of the curves and physiological function. The goals of treatment include to stop the progression of the curve, restore the spinal alignment, prevent neurological deterioration or improve the neurology if it is already deteriorated, improvement of pulmonary function and improve cosmetic outcomes. The various surgical options are one stage correction with osteotomies, posterior only approach, staged anterior release and posterior approach, pre-operative optimization by halo traction followed by posterior fusion and temporary internal distraction.

The study protocol was published in PROSPERO with the ID CRD420251046131.Studies with participants diagnosed with severe rigid scoliosis who were operated and reporting the baseline values and correction of the scoliosis at follow-up were included. Studies mentioning the type of procedure and complications associated with the procedure were also included. Studies dealing with exclusive kyphosis, infective deformities, porcine models, adult degenerative lumbar scoliosis and those that did not give details about the scoliosis correction were excluded.

A total of Seventy-Five studies were included with 2314 patients. Both neurological and non-neurological complications were significantly more likely in osteotomy compared to halo traction followed by definitive surgery. The difference was very significant in neurological complications (RR∼3.76, 95 % CI = 2.52-5.60).

Among the various strategies employed to treat severe rigid scoliosis, Spinal Osteotomy techniques had the highest rates of neurological and non-neurological complications. All the techniques described like halo traction, osteotomy and staged procedures gave a good curve correction in severe rigid scoliosis.