Combined anterior release-halo traction-posterior spinal fusion and posterior release-halo-traction-posterior spinal fusion versus 1-stage posterior-only spinal fusion for severe pediatric scoliosis: a 6-year single-center study.

backgroundSevere scoliosis in children can cause cardiovascular, respiratory, and functional impairments. Treatment options include anterior, posterior, and combined surgical approaches, often using traction methods like Halo-gravity traction (HGT). This study evaluates the effectiveness and safety of single-stage posterior-only (PO) correction for scoliosis curves over 90°. It compares it with other methods involving anterior or posterior release and HGT followed by posterior spinal fusion (PSF).

methodsThe study involved 52 pediatric scoliosis patients with Cobb angles ≥ 90°, treated between January 2017 and September 2022. It compared three treatments: single-stage posterior spinal fusion (PO group, 35 patients), posterior release with temporary instrumentation, postoperative HGT, and final posterior fusion (PHP group, 9 patients), and anterior release, postoperative HGT, and final posterior fusion (AHP group, 8 patients). The primary outcome was the coronal correction rate (CR) of scoliosis curves. Secondary outcomes included major perioperative complications (> IIIB, according to Clavien-Dindo classification), surgery duration, blood loss, and hospital stay length (LOS). A one-way ANOVA test or Chi-Square test were used.

resultsThe mean CR for major and minor curves was 65.2 ± 10.5% and 57.9 ± 12.8% for the PO group, 50.7 ± 10.1% and 54.3 ± 18.1% for the PHP group, and 59.2 ± 11.5% and 60.8 ± 15.4% for the AHP group (p = 0.101 and p = 0.733, respectively). There were 13 recorded complications in total for the PO group (37.1%), 2 complications for the PHP group (22.2%), and 6 complications for the AHP group (75%) (p = 0.533). Mean blood loss was 787 ± 437 mL for group PO, 1050 ± 251.8 mL for group PHP, and 1090 ± 324.4 mL for group AHP (p = 0.033). Total surgical time was roughly 5 h per case for group PO, 8 h for group PHP, and 9 h for group AHP (p < 0.05). The mean LOS was equal to 9 ± 4.3 days for the PO group, 25 ± 6.5 days for the PHP group, and 36 ± 4.3 days for the AHP group (p < 0.05).

conclusionsOne-stage PSF seems to be effective and exhibits a satisfactory safety profile for treating severe scoliosis over 90 degrees, providing a viable alternative to combined approaches. A combined posterior approach may be preferred for very rigid curves or low-weight patients to minimize the risk of wound-related complications. Further prospective, multicentric studies are required to refine treatment guidelines.