One-stage posterior-only correction in severe and rigid scoliosis exceeding 90°: radiographic and surgical outcomes.

Abstract

Purpose: Scoliosis, if left untreated, can lead to severe curvatures exceeding 90°, causing devastating functional impairments. Various surgical methods exist, but the optimal approach is still debated. One-stage posterior spinal fusion (PSF)-only surgery is gaining favor for its comparable outcomes and reduced morbidity. This study, focusing on radiographic and surgical outcomes, evaluates the efficacy and safety of one-stage PSF for scoliosis curves over 90° in pediatric patients.

Methods: Thirty-five pediatric patients with scoliosis (Cobb angle ≥ 90°) who underwent one-stage posterior spinal fusion (PSF)-only surgery from January 2020 to December 2023 were included. Patients with idiopathic, neuromuscular, or syndromic scoliosis were included. The primary outcome was the correction rate (CR) of scoliosis curves. Secondary outcomes included major postoperative complications, surgery duration, blood loss, and hospital stay length. Preoperative and postoperative radiographic and clinical data were analyzed.

Results: The mean CR for major and minor curves was 65.2 ± 10.5% and 57.9 ± 12.8%, respectively. The mean preoperative and postoperative Cobb angle of major and minor curves was 102.6° and 35.6°, 68.6° and 28.8°, respectively. There were 13 recorded complications, with only one being life-threatening. Mean blood loss was 787 ± 437 ml. Total surgical time was roughly 5 h per case. The mean length of hospital stay (LOS) was 9 days.

Conclusions: PSF-only surgery for severe scoliosis over 90° is effective and safe. It supports using posterior-only methods as a viable alternative to combined approaches, suitable for patients with even more severe curves when their condition allows.