[Outcome after surgical treatment of idiopathic scoliosis using three- dimensional correction with spondylodesis].

BACKGROUND [corrected] Three-dimensional surgical correction of scoliosis was introduced in the 1980s by Cotrel-Dubousset. Initially only laminar and pedicular hooks, two rods (correcting and stabilizing), and transverse links joining both rods were used to correct and stabilize the spine. When implant systems had been developed and modernized, transpedicular screws in the lumbar segment were used, followed by titanium implants. The aim of our study was to evaluate the outcome after surgical correction of scoliosis using the three-dimensional correction method with spondylodesis. MATERIAL AND METHOD We studied 171 patients with scoliosis treated surgically by the three-dimensional method of correction in the years 1992-2002. These were patients with idiopatic scoliosis not exceeding 70-80 degrees , depending on the degree of correction in extension tests. In 28 cases, titanium implants were used. In most cases, transpedicular screws were used in the lumbar spine, on the convex side of the scoliosis. Tytanium implants were used to enable diagnosis by CT or MRI after surgery. RESULTS The mean angle of scoliosis before surgery was 56 degrees (range 40 degrees -90 degrees ). After surgical correction the mean angle was 16 degrees (range 5 degrees -37 degrees ); however, in long-term follow-up, the mean angle had increased slightly to 18 degrees (range 8 degrees -50 degrees ). The observation period was 2 to 16 years. There were complications in 9.3% of these cases, mainly late sterile negative tissue reactions to steel implants. Infectious and neurological adverse reactions were not observed. CONCLUSIONS The best outcome after surgical treatment was achieved in grade II scoliosis. The scale of correction amounted to an average 70%. Transpedicular screws in the lumbar spine enabled a reduced range of stabilization. Titanium implants enabled radiological diagnosis by MRI and CT after surgery.