Autogenous tibial strut grafts used in severe kyphoscoliosis: surgical policies and preliminary results

Background Surgery for severe kyphoscoliosis is frequently unsatisfying because of loss of correction, high rate of pseudarthrosis and neurological complications. Several authors reported that the anterior fusion with strut grafts might improve the surgical outcome. This article describes and assesses the surgical. strategies and the application of autogenous tibial strut in the treatment of severe kyphoscoliosis. Methods Severe kyphoscoliosis patients (n = 39) admitted from April 1998 to September 2003 formed the study group. Different surgical strategies had been used according to the flexibility, neurological function and curve level. All patients received staged anterior and posterior surgery with a tibial strut used in the anterior fusion. The patients were followed up for 9 months to 6 years ( mean 37 months). Results The mean preoperative and postoperative kyphosis was 82 degrees and 52 degrees respectively, and the mean scoliosis was 84 degrees and 44 degrees respectively. Complications included pseudarthrosis (2 cases, one with graft fracture and the other with hook displacement), posterior elements fractures (4), pleura penetrations (3, in the plastic surgery of the thoracic cage), dura tear (2), exudative pleuritis (2, in the anterior surgery), and tibia fracture of the harvesting site ( 1). The mean loss of correction in coronal and sagittal plane was 6 degrees and 7 degrees respectively. Except for 1 case, the patients with incomplete paraplegia showed improvements to varying extents. Conclusion Autogenous tibial strut can provide excellent support to the kyphoscoliotic spine: it reduces pseudarthrodic rate, loss of correction and complications of graft harvest, it also prevents the occurrence of neurological impairment.