Posterior pedicle screws combined with shortening and release techniques for lumbar and thoracolumbar adolescent idiopathic scoliosis

OBJECTIVE: To prospectively evaluate the clinical and radiographic effects of posterior surgery with wide posterior shortening release and segmental pedicle screws techniques in a consecutive group of patients with thoracolumbar /lumbar adolescent idiopathic scoliosis. METHODS: Between April 2002 and July 2005, 114 patients (86 women and 28 men) were enrolled in this study. There were 72 Lenke type 5, 32 Lenke type 6, and 10 Lenke type 3C curves. Radiographic parameters such as coronal plane Cobb angle; lordosis angle; lowest instrumented vertebrae (LIV) angulation; and the distances from the central sacral vertical line (CSVL) to the LIV, to the apical vertebra and to the C7 plumb line, were analyzed. Complication rates were also recorded during follow-up. RESULTS: The average coronal correction was from 61° to 13° (78.6%). In the sagittal plane, lumbar lordosis was normalized from 36° with a wide range (23°-67°) to 42° with a normal range (34°-55°). The LIV had 79% correction of coronal angulations. The center sacral line to LIV was improved from 2.3 cm to 0.5 cm, apex to center sacral line from 5.0 cm to 1.6 cm, and CSVL from 2.7 cm to 0.8 cm. A total of 1460 pedicle screws were placed safely, average 9.6 levels (5-14) were fused. The patients were followed up for an average of 30 months (range, 12-50). There was excellent maintenance of correction at final follow-up. CONCLUSION: Wide posterior release and segmental pedicle screw instrumentation has excellent radiographic and clinical results with minimal complications.