Treatment of Scoliosis with One-Stage Posterior Pedicle Screw System by Paraspinal Intermuscular Approach: A Minimum of Two Years of Follow-Up

Objective To evaluate the clinical efficacy of the treatment of scoliosis with a pedicle screw system through paraspinal intermuscular approach (PIA). Methods This is a retrospective case series study. A total of 10 patients diagnosed with scoliosis had surgical indications and treated with a pedicle screw system in one-stage posterior surgery by PIA from March 2013 to April 2015 at the First Hospital of Jilin University were enrolled in this study. The average age of the patients was 14.9 years, including one male and nine females. The operative information and surgical results, including Cobb angle correction, correction loss, global balance (including Frontal Plane Balance [FPB] and Sagittal Plane Balance [SPB]), and fusion rate were reviewed. Functional outcomes including visual analog scale (VAS) back pain score, leg pain score, and Scoliosis Research Society-22 questionnaire (SRS-22) were used to evaluate the quality of life of patients preoperatively and at last follow-up. Results Each patient was followed up at least six times. The average follow-up time was 43.2 months. Mean scoliosis and kyphosis improved from 68.5 degrees +/- 18.1 degrees to 18.7 degrees +/- 11.8 degrees and from 34.4 degrees +/- 17.9 degrees to 24.0 degrees +/- 6.7 degrees, respectively (p < 0.05); at last follow-up, it was 20.1 degrees and 24.7 degrees, respectively (p > 0.05). During the follow-up, mean coronal and sagittal correction loss was 1.4 degrees +/- 1.2 degrees and 0.7 degrees +/- 0.8 degrees, respectively (p > 0.05). Mean FPB improved from 32.7 to 11.7 mm (p < 0.05); Mean SPB changed from 0.3 to -0.7 mm (p > 0.05). No dural tears were observed during the corrective surgery or wound infection or implant-related complications. No pseudoarthrosis was identified according to the last follow-up three-dimensional (3D) CT scan. All the domains in SRS-22 questionnaire show statistically significant improvement at the last follow-up (p < 0.05). The VAS back pain scores improved from a mean preoperative score of 1.7 to a mean postoperative score of 0.2 (p < 0.05). Conclusion This original one-stage posterior PIA is safe and effective in the treatment of scoliosis, which is characterized with less blood loss, shorter operation time, and satisfactory bony fusion.