Surgical techniques for the management of severe rigid scoliosis

Severe rigid scoliosis presents some unique challenges with respect to surgical techniques and complications. Anterior and posterior techniques, as well as combined approaches, can be employed for the surgical management of this condition. The purpose of this article is to describe severe rigid scoliosis as an entity and to delve into the surgical tools that may be utilized for the treatment of this complex condition. Specific techniques are presented in detail, including preoperative halo-gravity/halo-pelvic traction, as well as correction maneuvers such as anterior release, thoracoplasty, concave rib osteotomy, and posterior vertebral column resection. Preoperative halo traction improves curve flexibility and pulmonary status, anterior release and concave rib osteotomy enhance mobilization, thoracoplasty addresses rib prominence, and posterior vertebral column resection provides powerful single-stage correction. Collectively, these techniques expand surgical options and mitigate neurologic and cardiopulmonary risks in severe rigid scoliosis.