Cantilever bending technique for treatment of large and rigid scoliosis

Study Design. Retrospective review of a consecutive clinical series. Objectives. To assess the efficacy and clinical value of cantilever bending technique as a technique for correcting large (greater than or equal to70degrees) and rigid (flexibility less than or equal to30%) scoliosis. Summary of Background Data. Scoliosis correction by current methods is a compromise between the rigidity of the deformity and corrective forces provided by these methods. For large and rigid scoliosis, the rigidity of the deformity cannot be overcome enough to achieve satisfactory correction. Thus, anterior release procedures are usually necessary to make the curves more flexible and thus improve correction. The cantilever bending technique provides powerful corrective forces for overcoming the rigidity of the deformity and obviates the need for anterior release procedures. The utility and efficacy of the method alone without anterior release for treating large and rigid deformity has not been demonstrated. Methods. A total of 41 consecutive patients undergoing cantilever bending technique for the management of large and rigid scoliosis of any etiology (congenital, idiopathic, or neuromuscular) were included. Radiographic studies, complications, and satisfaction assessment using the modified Scoliosis Research Society Instrument were used to assess outcomes. Results. The mean Cobb angle of the major curves was 98degrees (range 75-133degrees). The deformity correction was 67.1% (range 51-74%). Coronal imbalance was 2.5 cm before and 0.8 cm after surgery. No major complication occurred. Satisfactory correction was achieved in all patients and without anterior release in all but one patient. Regardless of the etiology of their deformities, all patients were very satisfied with their outcomes. Conclusions. The cantilever bending technique is an effective procedure for the management of large and rigid scoliosis regardless of etiology. The clinical value of the procedure was demonstrated by reduced need for anterior release, fewer complications, and high rates of patient satisfaction.