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Background <p>Severe scoliosis in children can cause cardiovascular, respiratory, and functional impairments. Treatment options include anterior, posterior, and combined surgical approaches, often using traction methods like Halo-gravity traction (HGT). This study evaluates the effectiveness and safety of single-stage posterior-only (PO) correction for scoliosis curves over 90°. It compares it with other methods involving anterior or posterior release and HGT followed by posterior spinal fusion (PSF).</p> Methods <p>The study involved 52 pediatric scoliosis patients with Cobb angles ≥ 90°, treated between January 2017 and September 2022. It compared three treatments: single-stage posterior spinal fusion (PO group, 35 patients), posterior release with temporary instrumentation, postoperative HGT, and final posterior fusion (PHP group, 9 patients), and anterior release, postoperative HGT, and final posterior fusion (AHP group, 8 patients). The primary outcome was the coronal correction rate (CR) of scoliosis curves. Secondary outcomes included major perioperative complications (&gt; IIIB, according to Clavien-Dindo classification), surgery duration, blood loss, and hospital stay length (LOS). A one-way ANOVA test or Chi-Square test were used.</p> Results <p>The mean CR for major and minor curves was 65.2 ± 10.5% and 57.9 ± 12.8% for the PO group, 50.7 ± 10.1% and 54.3 ± 18.1% for the PHP group, and 59.2 ± 11.5% and 60.8 ± 15.4% for the AHP group (<i>p</i> = 0.101 and <i>p</i> = 0.733, respectively). There were 13 recorded complications in total for the PO group (37.1%), 2 complications for the PHP group (22.2%), and 6 complications for the AHP group (75%) (<i>p</i> = 0.533). Mean blood loss was 787 ± 437 mL for group PO, 1050 ± 251.8 mL for group PHP, and 1090 ± 324.4 mL for group AHP (<i>p</i> = 0.033). Total surgical time was roughly 5&#xa0;h per case for group PO, 8&#xa0;h for group PHP, and 9&#xa0;h for group AHP (<i>p</i> &lt; 0.05). The mean LOS was equal to 9 ± 4.3 days for the PO group, 25 ± 6.5 days for the PHP group, and 36 ± 4.3 days for the AHP group (<i>p</i> &lt; 0.05).</p> Conclusions <p>One-stage PSF seems to be effective and exhibits a satisfactory safety profile for treating severe scoliosis over 90 degrees, providing a viable alternative to combined approaches. A combined posterior approach may be preferred for very rigid curves or low-weight patients to minimize the risk of wound-related complications. Further prospective, multicentric studies are required to refine treatment guidelines.</p>

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Combined anterior release-halo traction-posterior spinal fusion and posterior release-halo-traction-posterior spinal fusion versus 1-stage posterior-only spinal fusion for severe pediatric scoliosis: a 6-year single-center study

  • 期刊论文

  • 发表日期：

    2026年2月23日

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  • De Salvatore Sergio,
  • Oggiano Leonardo,
  • Brigato Paolo,
  • Palombi Davide,
  • Sergio Sessa,
  • Umile Giuseppe Longo,
  • Laura Ruzzini,
  • Pier Francesco Costici

摘要

Background

Severe scoliosis in children can cause cardiovascular, respiratory, and functional impairments. Treatment options include anterior, posterior, and combined surgical approaches, often using traction methods like Halo-gravity traction (HGT). This study evaluates the effectiveness and safety of single-stage posterior-only (PO) correction for scoliosis curves over 90°. It compares it with other methods involving anterior or posterior release and HGT followed by posterior spinal fusion (PSF).

Methods

The study involved 52 pediatric scoliosis patients with Cobb angles ≥ 90°, treated between January 2017 and September 2022. It compared three treatments: single-stage posterior spinal fusion (PO group, 35 patients), posterior release with temporary instrumentation, postoperative HGT, and final posterior fusion (PHP group, 9 patients), and anterior release, postoperative HGT, and final posterior fusion (AHP group, 8 patients). The primary outcome was the coronal correction rate (CR) of scoliosis curves. Secondary outcomes included major perioperative complications (> IIIB, according to Clavien-Dindo classification), surgery duration, blood loss, and hospital stay length (LOS). A one-way ANOVA test or Chi-Square test were used.

Results

The mean CR for major and minor curves was 65.2 ± 10.5% and 57.9 ± 12.8% for the PO group, 50.7 ± 10.1% and 54.3 ± 18.1% for the PHP group, and 59.2 ± 11.5% and 60.8 ± 15.4% for the AHP group (p = 0.101 and p = 0.733, respectively). There were 13 recorded complications in total for the PO group (37.1%), 2 complications for the PHP group (22.2%), and 6 complications for the AHP group (75%) (p = 0.533). Mean blood loss was 787 ± 437 mL for group PO, 1050 ± 251.8 mL for group PHP, and 1090 ± 324.4 mL for group AHP (p = 0.033). Total surgical time was roughly 5 h per case for group PO, 8 h for group PHP, and 9 h for group AHP (p < 0.05). The mean LOS was equal to 9 ± 4.3 days for the PO group, 25 ± 6.5 days for the PHP group, and 36 ± 4.3 days for the AHP group (p < 0.05).

Conclusions

One-stage PSF seems to be effective and exhibits a satisfactory safety profile for treating severe scoliosis over 90 degrees, providing a viable alternative to combined approaches. A combined posterior approach may be preferred for very rigid curves or low-weight patients to minimize the risk of wound-related complications. Further prospective, multicentric studies are required to refine treatment guidelines.