Clinical Application Of Paraspinal Intermuscular Approach In The Surgical Treatment Of Adolescent Idiopathic Scoliosis

Background:Adolescent idiopathic scoliosis is the most common type of idiopathic scoliosis,but its exact cause is not clear.Now, there are two main types of treatment:non operative treatment and surgical treatment. The former includes:Physical therapy, manual therapy, electrical stimulation therapy, etc,the most widely accepted non surgical treatment remains to be observed and orthopedic brace treatment.The purpose of surgical treatment is based on the development history of the deformity and the potential consequences of the deformity. For children and adolescents,surgical treatment should be considered if it is expected to be a serious problem.The operative methods included anterior, posterior and combined anterior and posterior approach. From the first case of scoliosis surgery,many scholars have made a lot of improvements to the internal fixation system, orthopedic and bone graft fusion,gradually improve the safety of surgery, reduce complications, improve the fusion rate, so that the concept of scoliosis correction times of change.But few scholars have put the line of sight on the operative approach. Purpose:To evaluate the clinical efficacy of posterior three-dimensional correction, bone graft fusion and pedicle screw fixation by the intervertebral space approach in the treatment of adolescent idiopathic scoliosis. Method:6 patients of adolescent idiopathic scoliosis, all of the patients are female, the average age of 14.33 years old(10-20 years).The main curve region involved vertebral 5-8, with an average of 6.83.Measurement of Cobb angle at the time of preoperative, postoperative and follow-up, measurement methods Fig 1.Statistical imaging and clinical data of all patients before and after operation.All operations were performed under SEP(somatosensory evoked potential) monitoring.Posterior median approach,after the skin and subcutaneous tissue were cut through the layers, the 2cm was cut open at both sides of the spine,lumbar incision thoracic dorsal thoracic incision lumbodorsal fascia, superficial muscles(levator muscle of scapula, rhomboid muscle, trapezius muscle),the deep muscle groups were exposed, and the gap between the longest and the medial and lateral muscles was separated until the bilateral joints were exposed.And then implanted pedicle screw, three-dimensional orthopedic, bone graft fusion. Result:The average operation time was 267.5 minutes(215-345 minutes), the average amount of blood loss was 156.17ml(80ml-213ml), intraoperative blood transfusion was 0.Safe implantation of pedicle screws 77, with an average of 12.83, the position of the nail is satisfactory, no related complications.Fused pyramidal number average of 8.33(7-10). Preoperative Cobb angle was 62 degrees(49-92 degrees), the average Cobb angle was 13.5 degrees(0-25 degrees), the last follow-up Cobb angle averaged 14.33 degrees(0-28 degrees).Preoperative expected correction rate of 71.5%, the immediate postoperative correction rate of 78.5% and last follow-up correction rate for 77.33%. Statistical analysis(SPSS S21.0): postoperative immediate effect and the last followup curative effect exact(P < 0.05) and follow-up correction lost statistical significance(P > 0.05). Conclusion:1.adolescent idiopathic scoliosis, the paraspinal muscle gap approach was adopted. Three dimensional correction graft bone fusion and pedicle screw internal fixation can obtain satisfactory curative effect. 2. the intervertebral space of the bone graft showed strong bony fusion.3.Using the paraspinal muscle gap approach for the treatment of adolescent idiopathic scoliosis can effectively reduce the intraoperative and postoperative bleeding, shorter operative time, achieve zero blood transfusion during the operation.