Perioperative outcomes of severe adolescent idiopathic scoliosis (AIS) patients with Cobb angle ≥ 100°: Feasibility of single-staged posterior spinal fusion with radical facetectomies.

Introduction: Surgical strategies for severe scoliosis often necessitate extensive approaches and major osteotomies to achieve optimal results. The objective of this study is to assess the perioperative outcomes of severe AIS patients with Cobb angle ≥100° undergoing single-staged posterior spinal fusion (PSF) without major osteotomies and pre-operative halo traction. Research question: Is it feasible to perform a single-stage PSF without major osteotomies for AIS patients with Cobb angle ≥100°? Material and methods: Thirty-five severe AIS patients with Cobb angle ≥100° who underwent single-staged PSF without major osteotomies or pre-operative halo traction between 2019 and 2023 in a single tertiary centre were recruited. Outcomes were operation duration, intra-operative blood loss, rate of allogenic blood transfusion, correction rate, length of hospital stay and complication rate. Results: The mean operation duration was 212.6 ± 67 min. The mean intra-operative blood loss was 1121.3 ± 435.2 mL. 14.3% of patients required allogenic blood transfusion. The average number of fusion levels was 13.2 ± 0.9, and the mean correction rate achieved was 52.6 ± 11.2 %. Total hospital stay was 4.5 ± 0.9 days, and the complication rate was 8.6 %. Two patients developed pleural effusion, while one patient had a superficial surgical site infection. Discussion and conclusion: The use of a single-staged PSF with radical facetectomies without major osteotomies is a compelling and feasible surgical strategy for severe AIS patients with Cobb angle ≥100°. This surgical approach not only demonstrates efficacy in achieving satisfactory results but also showcases a notable reduction in the complication rate and a shorter hospital stay.