Does Wide Posterior Multiple Level Release Improve the Correction of Adolescent Idiopathic Scoliosis Curves? Javier Pizones, MD, PhD, Enrique Izquierdo, MD, PhD, Felisa Sa ´nchez-Mariscal, MD, Patricia A ´ lvarez, MD, Lorenzo Zu ´n ˜iga, MD, and Alejandro Go ´mez, MD Study Design: Retrospective matched cohort study. Objective: To compare results of posterior correction and fusion with a hybrid construct using a standard posterior release (SPR) versus adding a wide posterior release (WPR), in adolescent idiopathic scoliosis (AIS) treated at a single institution, with a minimum 2-year follow-up. Summary of Background Data: Although the importance of posterior release has been enhanced for the correction of AIS, there have been no reports comparing correction results when posterior wide release (excision of all posterior ligaments and bilateral extended facetectomy at multiple levels) is used. Methods: A retrospective study of 46 patients with AIS was performed. Posterior-only hybrid instrumentation with subla- minar wires was included. SPR group consisted of 25 patients and WPR group consisted of 21 patients. Results: There was no difference in sex, age, type of curve, number of instrumented levels, length of surgery, and pre- operative main curve Cobb (SPR: 60 ± 10 degrees WPR: 59 ± 8 degrees). In the WPR group, the amount of main curve correction obtained was significantly greater (SPR: 57% vs. WPR: 68.6%) P <0.001, and maintained at final follow-up (SPR: 51.6% vs. WPR: 61.8%) P <0.05. Preoperative and postoperative proximal thoracic and lumbar secondary curves were similar in both the groups. T5-T12 preoperative kyphosis were (SPR: 22.2 ± 11 degrees vs. WPR: 19 ± 11 degrees) the degrees corrected in postoperation (SPR: +1.2 ± 6 degrees vs. WPR:  0.9 ± 9 degrees) and at final follow-up (SPR: +1.6 ± 8 degrees vs. WPR:  0.8 ± 11 degrees), and were not statistically different P >0.05. Minor complications were similar in both groups and no major complications were found. Conclusions: Posterior wide release at multiple levels improves coronal main curve correction in patients with AIS, without an increase in the incidence of complications. Furthermore, it improves fusion surface and makes insertion of sublaminar wires easier. Key Words: adolescent idiopathic scoliosis, wide posterior release, hybrid instrumentation (J Spinal Disord Tech 2010;23:e24–e30) O ver the past few years, the pedicle screw instrumen- tation used in the correction of adolescent idiopathic scoliosis (AIS) has gained in popularity due to its percei- ved superior power of correction 1 and vertebral grip when compared with the hook construct. 2–4 Even so, some still consider the hybrid construct (proximal hooks, distal screws, and apical sublaminar wires) as an effective tool for the correction of scoliosis, 5,6 even for curves greater than 100 degrees. 4 At our institution, we have used the hybrid construct as our preferred method of correction for the majority of the curves, usually by translating the apex of the thoracic scoliosis to a precontoured sagittal rod by means of sublaminar wires. 7–9 We have been progressively more aggressive in the surgical treatment of stiff curves, adding wider posterior releases to the standard posterior ap- proach. 10,11 These extended releases include a complete excision of: the spinous process, the supra and interspinous ligaments and the ligamentum flavum, in combination with a bilateral extended facetectomy. To the best of our knowledge, no one has reported the comparative results in the correction of scoliosis, when the posterior wide release is performed. Some authors have described the need for posterior bone and soft tissue releases 11–14 and extended facet joint exposures 15,16 to properly place the instrumenta- tion. But they do not analyze the exact effect that this release causes in the correction of the deformity. Our aim was to compare the initial postoperative and sustained (2-year follow-up) correction of AIS curves, using a post- erior hybrid construct with and without a wide posterior surgical release. MATERIALS AND METHODS All the patients in the study suffered from AIS, and were surgically treated by the same surgeon (E.I.) using a Copyright r 2010 by Lippincott Williams & Wilkins Received for publication June 4, 2009; accepted September 23, 2009. From the Spine Unit, Department of Orthopaedic Surgery, Hospital Universitario de Getafe, Madrid, Spain. No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript. The device(s)/drug(s) is/are approved by Food and Drug Administration or a corresponding national agency for this indication. All authors give permission to reproduce copyrighted material. This study has the IRB/Research Ethics Committee approval. Reprints: Javier Pizones, MD, PhD, Department of Orthopaedic Surgery, Hospital de Getafe, Carretera de Toledo Km. 12.5 28905. Madrid, Spain (e-mail: javier.pizones@wanadoo.es). ORIGINAL ARTICLE e24 | www.jspinaldisorders.com J Spinal Disord Tech  Volume 23, Number 7, October 2010