ABSTRACT

Purpose:

The aim of this retrospective clinical trial was to evaluate the efficacy of a three-rod technique with a posterior approach in the surgical treatment of rigid spinal deformities, including scoliosis and kyphoscoliosis.

Materials and Methods:

Between 2003 and 2009, ten patients with severe and rigid spinal deformities (five with scoliosis and five with kyphoscoliosis) that were treated surgically using a three-rod technique with a posterior approach and instrumentation were retrospectively evaluated. Of the ten patients, six were female and four were male. Seven patients were idiopathic and three had a congenital-originated deformity. The mean age at the time of surgery was 20.3 years old (range: 14–38). In a radiographic assessment, parameters including the Cobb angles of the curves, the sagittal and coronal balance measurements, the apical vertebral translation, the thoracic kyphosis with lumbar lordosis, and the correction that was both gained and lost were recorded in the preoperative, postoperative, and final follow-up periods.

During the procedure, the apex of the concavity of the main curve was firstly instrumented and distracted (first rod). Then, a second rod was inserted to the highest and lowest vertebrae of the concavity, followed by derotation and distraction (second rod). A long third rod was then inserted to the convexity of the deformity (third rod).

Results:

The mean follow-up was 48.8 months. The mean preoperative Cobb angle of the major thoracic curve was 102.6° (range: 67–132°), which improved to 56° (range: 26–96°) in the early postoperative period, and was measured as 58.1° (range: 27–98°) in the final follow-up. The mean initial correction was measured as 45.42%, and the final correction rate was 43.37%. The loss of correction at the end of the follow-up period was 2.05%. Two patients had sagittal and one had coronal decompensation as complications.

Discussion:

The treatment of rigid and severe scoliosis or kyphoscoliosis is difficult. Rigid and severe spinal deformities can be treated with various osteotomies and posterior and/or anterior techniques. Based on our results, we suggest that a three-rod technique with a posterior approach may be an effective and safe mode of surgical treatment for the management of severe and rigid spinal deformities such as scoliosis and kyphoscoliosis.