Two-stage Posterior-only Correction in Severe, Rigid Scoliosis in Adolescent and Young Adult – A Retrospective Study

Abstract Background: The available surgical data regarding the two-stage posterior approach remain limited. Objectives: The objective of this study was to evaluate the efficacy and safety of a two-stage posterior correction approach for severe, rigid scoliosis in adolescents and young adults. Materials and Methods: Seven patients (mean age: 17.9 years) with severe, rigid scoliosis underwent two-stage posterior-only surgery involving posterior instrumentation, posterior column osteotomies, and fusion between 2014 and 2022. Clinical data included radiographic outcomes, operation time, blood loss, hospital/intensive care unit (ICU) stays, and complications. The mean follow-up period was 37 ± 29.1 months. Results: The preoperative coronal major curve (101.2° ±6.36°) improved to 43.83° ±8.61° after the two-stage operation ( P < 0.05). The correction rate is about 56.7%. During the follow-up, there was a 5.3° correction loss. Thoracic kyphosis and lumbar lordosis improved significantly ( P < 0.05), with correction rates of 30.83% ±17.18% and 28.9% ±29.72%, respectively. The mean hospital stay was 19.3 ± 5.8 days, ICU stay was 2 ± 1.6 days, and operation times were 441 ± 50.9 min (first stage) and 268 ± 119.1 min (second stage). Estimated blood loss was 1186 ± 526.6 mL and 814 ± 882.6 mL for the first and second stages, respectively. No patients experienced postoperative neurologic deficits, instrument complications, or infections. Conclusions: Two-stage posterior-only correction offers a safe and effective alternative for treating severe, rigid scoliosis. It achieves gradual correction while reducing pulmonary risks, neurological complications, and intraoperative blood loss. For hospitals without navigation systems, this approach remains a viable surgical option.