ABSTRACT

Description of correction of severe scoliosis with modified Cantilever bending technique without anterior discectomy or osteotomy.

Ponte, PSO and VCR type posterior osteotomies are often required for the treatment of rigid deformations above 55°. However, these procedures are monitored with high neurological deficit and bleeding risks, and according to the knowledge of some authors, complications can reach 80 % and can be experienced not only during the operation, but also 6 months after the postoperative period. The classic Cantilever maneuver was described by Kao-Wha Chang in 2003 and is said to have been implemented in 1998. In this study, we will discuss the correction of severe scoliosis with modified Cantilever bending technique without anterior discectomy or osteotomy.

The technique was performed in 24 patients. 2 of them were male and 22 were female. The age of the patients was between 12-32, the severity of deformity was 57°-120°. 1 or 1.5 years of outcomes are present.

The degree of major curvature was 82.78° ± 19.89° (min. 57°, max. 120°). In order to measure the flexibility of the curves, bending graphs were determined and an average of 21,58° ± 14,46° (% 26.10 ± % 13.69; minimum 2.0°, maximum 40.1°) was detected. This means as the all curves were rigid and severe curves in the patients (t: 2.01; p> 0.05). On the other hand, mean postoperative correction of the major curves was 50,08° ± 13,23° (% 60.49 ± % 14.14; minimum 33.5°, maximum 82.3°) with statistically significance (t:14.85; p<0.01). Postoperative correction percentages were higher than the correction of the curves in the bending graphics with statistically significance (t: -15.42; p< 0.01) Operations were performed without neuromonitarization, none of the patients had neurological complications. One patient had lumbar decompensation, which was corrected by fixing the L4 vertebra. There was no dislocation during the operation, no infection was detected, there were no death issues, and blood loss was 200-250 ml. No clinical signs were observed in follow ups. Thoracoplasty was not performed in any patient and there was no patient complaint requiring thoracoplasty. During the operation, only facetectomies were used, and neither anterior release nor posterior vertebral osteotomies were performed.

We think that the technology does not thoroughly modify the principles of correction and require any special instruments and skills to be applied, so it can widely be used and outcomes observed.