Comparison of anterior and posterior vertebral column resection versus anterior release with posterior internal distraction for severe and rigid scoliosis

This study aimed to compare efficacy, safety, and cost between staged vertebral column resection (VCR) and anterior release with internal distraction in treating severe and rigid idiopathic scoliosis. We examined the records of 43 patients with severe and rigid idiopathic scoliosis treated in our hospital. Group A included 26 patients who underwent anterior VCR followed by posterior vertebral column resection and instrumentation from July 2007 to October 2009. Group B included 17 patients who underwent anterior release with temporary posterior internal distraction, followed by posterior fusion and instrumentation from November 2009 to June 2011. The average preoperative main curve for group A was 101.3A degrees (range 90A degrees-130A degrees) and for group B was 104.8A degrees (range 90A degrees-136A degrees). Minimum follow-up was 2 years. Radiographic and clinical outcomes were compared between the groups. A t test demonstrated that the differences between the groups in preoperative and postoperative coronal and sagittal imbalance, thoracic kyphosis correction, and lumbar lordosis were not statistically significant. Patients in group B showed better postoperative (P = 0.031) and final (P = 0.030) main thoracic curve correction (76.8 and 75.6 %, respectively) than patients in group A (68.3 and 67.7 %, respectively). Patients in group B had better thoracolumbar or lumbar curve correction (85.8 %) than those in group A (76.8 %; P = 0.048). The differences in blood loss and operation time were not statistically significant (P = 0.094 and P = 0.060, respectively). Hospital stay was longer (P = 0.001) and patient cost was higher (P < 0.001) for patients in group B. One patient in group A required ventilator support for 12 h after anterior surgery. One transient dyspnea occurred in group B. No neurologic deficits occurred in either group. Anterior release with posterior internal distraction produces better corrective effects than anterior and posterior VCR, though hospital stay and costs are greater.