Radiologic comparison of posterior release, internal distraction, final PSO and spinal fusion with one-stage posterior vertebral column resection for multi-level severe congenital scoliosis

Background: To compare radiologic results of posterior release, internal distraction, and final pedicle subtraction osteotomy (PSO) and spinal fusionwith one-stage posterior vertebral column resection (PVCR) in treating multi-level severe congenital scoliosis. Methods: Forty-onesevere congenital scoliosis patients were used in the study. Group A comprised 24 patients who underwent one-stage PVCR. Group B comprised 17 patients who underwent posterior release with internal distraction, followed by final posterior fusion and instrumentation. The average preoperative main curve was 110.4 degrees (95-130 degrees) in group A and 109.4 degrees (range 90 degrees-126 degrees)in group B. Postoperative follow-up time was >= 2 years (2.0-4. 5 years) to analyze the radiographic and clinical outcomes. Results: A comparison of posterior release, internal distraction, and final spinal fusion with PVCR showed no significant differences in postoperative main curve and compensatory caudal curve correction, coronal and sagittal imbalance. However, significant differences were found between the 2 groups in compensatory cranial curve correction. Conclusions: Posterior release, internal distraction, and final spinal fusion produce better corrective results in compensatory cranial curve correction than PVCR in treating severe multi-level congenital scoliosis.