James E. Shook and Walter H. Burnham, Jr.

Goals of Surgical Treatment

The accordion procedure was developed to address problems associated with the large rigid thoracic curve. The surgical resection of the apical-convex curve reduces curve rigidity, which allows for greater curve correction.

Diagnosis

Significant rigid lateral deviation of the thoracic spine in the frontal plane with the apex of the curve between the T2 and T11-T12 disc.

Indications for Surgery

Large, rigid thoracic scoliosis curves (curves greater than 70 degrees that do not correct to less than 50 degrees on bending films).

Contraindications

Smaller and less rigid curves do not require a procedure of this magnitude.

Advantages

1. There is substantial reduction in curve rigidity and subsequent forces required for curve correction.

2. The curve is corrected by derotation and translation rather than distraction.

3. There is maintenance of concave blood supply to the spinal cord.

4. The spinal cord is protected by preservation of the posterior one third of the vertebral body.

5. The curve is corrected over multiple levels rather than an acute angular change.

6. Improved cosmesis.

7. Increased rates of fusion.

Disadvantages

1. Two surgical procedures are required.

2. Thoracotomy with associated morbidity.

3. Lengthened hospital course.

4. Postoperative bracing.

Procedure