The first experience of anterior dynamic correction of scoliosis in adolescents with complete growth and adults: surgical technique and immediate results

Abstract

Objective. To describe the technique of  anterior scoliosis correction in patients with completed growth and to analyze immediate results of its application.Material and Methods. Study design: retrospective clinical series. Level of evidence IV (D). A retrospective analysis of clinical and radiological data of 19 patients aged 13–44 years, who underwent anterior dynamic correction of typical idiopathic scoliosis, was performed.  Patients were divided into groups as follows: Group 1 (Lenke type 1 scoliosis) – 8 patients; Group 2 (Lenke 3) – 4 patients; and Group 3 (Lenke 5) – 7 patients. When analyzing clinical and radiological data, the age was taken into account; the deformity magnitude before and after surgery, and correction angle, were studied; and intraoperative blood loss, the number of fixed levels, duration of surgery and hospital stay length were evaluated. The functional status was assessed using the VAS and the SRS-22 questionnaire. Control examinations were carried out before and after surgery as well as at 4–6 weeks and 3, 6, and 12 months after surgery. The search for statistically significant differences was carried out between all groups in pairs: between groups 1 and 2, 2 and 3, and 1 and 3. Statistical analysis was conducted using Mann – Whitney U-test.  The SRS-22 and VAS data were processed using the Wilcoxon W-test.Results. The number of dynamically fixed levels varied from 6 to 12. The most proximal level of fixation was T5, the most distal – L4. The average time of surgery was 181 ± 28 minutes for transthoracic access and 198 ± 34 minutes for thoracophrenolumbotomy. The average length of hospital stay was 7.2 ± 1.5 days. In the intergroup comparison of indicators of  age, mean angle of deformity before and after surgery, mean angle of  correction and blood loss between groups with Lenke 1 and 3 scoliosis, no statistically significant differences were found. Comparison of the same indicators for groups with Lenke 1 and 5 scoliosis showed significant differences in the angles of deformity after surgery and in the number of fixed levels (p = 0.024 and p = 0.006, respectively). There were also no statistical differences between types 1 and 5. At 3 months after surgery the average SRS-22 score for all patients was 4.0 ± 0.42 (from 3.00 to 4.95). The VAS score changed from 6.9 ± 1.5 (4.0–9.0) before surgery to 4.4 ± 1.6 (1.0–7.0) which indicates the effectiveness of the treatment in the short term.Conclusion.  Analysis of the immediate results of  anterior dynamic correction of Lenke type 1, 3 and 5 scoliotic deformities in physically active young adults showed positive primary effectiveness in terms of VAS and SRS-22, which makes it possible to recommend this technique for use in the presented cohort of patients.  The method is effective for all studied types of scoliosis, with a greater efficiency in Lenke types 1 and 5. Further evaluation of long-term results on a larger clinical material will allow developing more precise indications and an algorithm for application of the method.