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Background: There is no consensus on the correction of adolescent idiopathic scoliosis (AIS) double major curves. Posterior only fusion may require extensive distal fusion or additional instrumentation, subsequently leading to a variety of complications. Alternatively, an anterior-posterior fusion (APF) is a powerful technique which can save lumbar motion segments while restoring lumbar apical rotation and tilt effectively. Methods: A retrospective review was performed at our institution (RNOH) for patients undergoing AIS correction. Two thousand three hundred and fourteen cases from 2006 to 2012 (minimum 2 year follow-up) were identified. Preoperative demographics and mean values of: Standing radiograph Cobb, Harrington Stable Zone, Supine Bending Radiograph Cobb and Postoperative mean values: Correction Rate, Supine Bend Flexibility and Supine Bending Flexibility Index, LIV Tilt and Rotation Perdriolle Grade. Results: Fifty-eight of 2,314 consecutive AIS cases were managed with a two stage anterior-posterior strategy. Comparison of preand post-operative radiographic parameters proved significant for cobb angle (MT: 62.7, 19.5; TL: 59.1,12.6; P<0.001), thoracic kyphosis (26.36°, 8.59°; P<0.001), lumbar lordosis (59.57°, 50.66°; P<0.001), LIV-ground angle (21.9°, 4.5°; P<0.001), and reduction in Perdriolle grade (1.7, 1.1; P<0.001). On average, the twostage APF approach saved 1.58 motion segments compared to the HSZ method. Conclusions: This technique achieved a high postoperative correction rate and supine bend correction index despite differing levels of stiffness, and an LIV of L3 or above was achieved in 90% of cases. The two stage APF surgical strategy attains desirable correction of coronal, sagittal, and rotational alignment in addition to saving lumbar motion segments compared to other methods.

mesentery and peritoneum

AB152. Two stage anterior-posterior fusion for double major adolescent idiopathic scoliosis (AIS): saving lumbar levels with improved derotation of the lowest instrumented vertebra