Chandirasegaran Saturveithan, Goparaju Praveen V N R, Chiu Chee Kidd, Chan Chris Yin Wei, Hasan Mohd Shahnaz, Kwan Mun Keong
Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
Care Hospital, Hi-tech City, Hyderabad, Telangana, 500032, India.
Brain Spine. 2025 Aug 7;5:104378. doi: 10.1016/j.bas.2025.104378. eCollection 2025.
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.
Is it feasible to perform a single-stage PSF without major osteotomies for AIS patients with Cobb angle ≥100°?
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.
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.
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.
重度脊柱侧弯的手术策略通常需要广泛的手术入路和大型截骨术以获得最佳效果。本研究的目的是评估Cobb角≥100°的重度特发性脊柱侧弯（AIS）患者在不进行大型截骨术和术前头环牵引的情况下接受单阶段后路脊柱融合术（PSF）的围手术期结果。
对于Cobb角≥100°的AIS患者，不进行大型截骨术而进行单阶段PSF是否可行？
招募了35例Cobb角≥100°的重度AIS患者，这些患者于2019年至2023年在单一三级中心接受了不进行大型截骨术或术前头环牵引的单阶段PSF。结果指标包括手术时间、术中失血量、异体输血率、矫正率、住院时间和并发症发生率。
平均手术时间为212.6±67分钟。平均术中失血量为1121.3±435.2毫升。14.3%的患者需要异体输血。平均融合节段数为13.2±0.9，平均矫正率为52.6±11.2%。总住院时间为4.5±0.9天，并发症发生率为8.6%。2例患者出现胸腔积液，1例患者发生表浅手术部位感染。
对于Cobb角≥100°的重度AIS患者，采用不进行大型截骨术的单阶段PSF联合根治性关节突切除术是一种有说服力且可行的手术策略。这种手术方法不仅在取得满意效果方面显示出有效性，而且并发症发生率显著降低，住院时间缩短。
