Does wide posterior multiple level release improve the correction of adolescent idiopathic scoliosis curves?

STUDY DESIGN Retrospective matched cohort study. OBJECTIVE To compare results of posterior correction and fusion with a hybrid construct using a standard posterior release (SPR) versus adding a wide posterior release (WPR), in adolescent idiopathic scoliosis (AIS) treated at a single institution, with a minimum 2-year follow-up. SUMMARY OF BACKGROUND DATA Although the importance of posterior release has been enhanced for the correction of AIS, there have been no reports comparing correction results when posterior wide release (excision of all posterior ligaments and bilateral extended facetectomy at multiple levels) is used. METHODS A retrospective study of 46 patients with AIS was performed. Posterior-only hybrid instrumentation with sublaminar wires was included. SPR group consisted of 25 patients and WPR group consisted of 21 patients. RESULTS There was no difference in sex, age, type of curve, number of instrumented levels, length of surgery, and preoperative main curve Cobb (SPR: 60±10 degrees WPR: 59±8 degrees). In the WPR group, the amount of main curve correction obtained was significantly greater (SPR: 57% vs. WPR: 68.6%) P<0.001, and maintained at final follow-up (SPR: 51.6% vs. WPR: 61.8%) P<0.05. Preoperative and postoperative proximal thoracic and lumbar secondary curves were similar in both the groups. T5-T12 preoperative kyphosis were (SPR: 22.2±11 degrees vs. WPR: 19±11 degrees) the degrees corrected in postoperation (SPR: +1.2±6 degrees vs. WPR: -0.9±9 degrees) and at final follow-up (SPR: +1.6±8 degrees vs. WPR: -0.8±11 degrees), and were not statistically different P>0.05. Minor complications were similar in both groups and no major complications were found. CONCLUSIONS Posterior wide release at multiple levels improves coronal main curve correction in patients with AIS, without an increase in the incidence of complications. Furthermore, it improves fusion surface and makes insertion of sublaminar wires easier.