The Journal of Bone and Joint Surgery, Vol 64, Issue 9 1307-1316, Copyright © 1982 by Journal of Bone and Joint Surgery, Inc
Osteotomy of the fusion mass in scoliosis
Y Floman, JN Penny, LJ Micheli, EJ Riseborough and JE Hall
The value of an osteotomy of the fusion mass in attaining realignment of
the spine when a lateral shift of the trunk over the pelvis has developed
in the frontal plane was studied in fifty-five patients. All had had a
previously fused but progressive spinal deformity. The indications for
osteotomy were progression of the curve, imbalance of the trunk, pain,
deteriorating cardiopulmonary function, or pseudarthrosis, or a combination
of these conditions. Twenty-one patients had idiopathic scoliosis;
fourteen, congenital scoliosis; ten, paralytic scoliosis; four,
myelodysplastic scoliosis; and six had scoliosis secondary to miscellaneous
conditions. A total of 154 osteotomies of the fusion mass, or 2.8
osteotomies per patient, were performed. Nine patients underwent an
anterior spinal osteotomy or wedge resection as well. Most had a two-stage
procedure which consisted of a posterior osteotomy, halo-femoral traction,
and a posterior re-fusion with Harrington instrumentation two weeks later.
At an average follow-up of thirty-two months, it was found that osteotomy
of the fusion mass enabled the surgeon to realign the trunk over the pelvis
and to correct pelvis obliquity, but correction of the angular deformity
was only secondary. Although the rate of complications was high (51 per
cent, including one postoperative death), osteotomy of the fusion mass and
re-fusion may be indicated in a patient with a previously fused but
progressively unbalanced, painful deformity of the spine.
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