[The operation treatment for severe and rigid idiopathic scoliosis].
OBJECTIVE: To discuss the operation treatment for the severe and rigid idiopathic scoliosis. METHODS: The clinical data of 24 patients with severe and rigid idiopathic scoliosis, 15 females and 9 males, with an average age of 17 (12 approximately 20) who had undergone operations from June 1999 to June 2003 were analyzed retrospectively. The patients were classified according to PUMC operative classification systerm, including 16 cases of type Ia, 2 cases of type Ib, 3 cases of type IIb2, and 1 case of types IIb1, IIc2, and IIc3 each. The average standing coronal Cobb angle was 98 degrees (80 degrees to 117 degrees ) and the average flexibility rate of the major curves was 20.8% (5% to 29.5%) before operation. Fifteen cases had sagittal deformities. Bone fusion was performed on all the cases according to the PUMC classification principles. 17 cases received anterior spinal release with posterior correction by two stages, and 2 cases by one stage. 5 cases received one-stage posterior correction. All the patients were followed up for 12 approximately 30 months (18 months on average). RESULTS: The mean standing coronal Cobb angle of the major curves was reduced to 58 degrees (32 degrees to 100 degrees ) after operation with a correction rate of 41.0% (10.9% to 61.0%). The results of sagittal plane correction were satisfying. The mean Cobb angle of the major curves at the final follow up was 63 degrees (31 degrees to 104 degrees ), and the mean lost was 5 degrees (0 degrees to 10 degrees ). One case had to undergo revision surgery because of hook displacement. One case had steel wire broken but without neurological symptoms and only needed observation. No pseudoarthrosis and decompensation occurred. CONCLUSION: Compared with vertebral osteotomy for the correction of scoliosis, the anterior spinal release combined with posterior correction and simple posterior correction have the advantages of low risk, less blood loss, and low infection rate. They can be used effectively and safely for the correction of idiopathic severe and rigid idiopathic scoliosis. The key points for the surgical procedures are appropriate correction and recovery of the balances of the coronal and sagittal planes.