A case of severe idiopathic adolescent scoliosis: the importance of a three-dimensional approach for optimal surgical outcomes, case report, and literature review

Purpose: Severe rigid adolescent idiopathic scoliosis (AIS) with Cobb angles ≥100° presents surgical challenges due to its structural stiffness and high complication rates. The optimal surgical approach remains debated, particularly between single-stage and multiple-staged correction. The aim of this manuscript is to report a representative case of severe AIS treated with a three-stage surgical strategy and to review the available literature comparing outcomes of staged versus single-stage approaches. Methods: A 16-year-old male with a 144.8° Lenke 3C+ AIS deformity was treated using halo gravity traction, anterior release, and posterior fusion. Pre- and postoperative radiographic and clinical parameters were analyzed. A systematic literature review was conducted in accordance with PRISMA guidelines using PubMed, Google Scholar, Scopus, and Cochrane databases (2005–2024), focusing on outcomes of staged versus non-staged surgeries in severe AIS. Results: The staged surgical approach resulted in a final Cobb angle of 20.1°, corresponding to an 86.1% correction. Significant improvements were also noted in apical vertebral translation and T1–S1 spinal length. No major complications were observed. The review included eight studies comprising 1011 patients. The mean correction rate was 61.9% for staged procedures versus 53.98% for single-stage interventions. Despite the increased hospitalization and resource demands, staged approaches demonstrated superior deformity correction and safer outcomes in select cases. Conclusion: In cases of severe rigid AIS, a three-stage approach combining halo traction, anterior release, and posterior fusion provides excellent deformity correction with an acceptable safety profile. Careful surgical planning and gradual correction are essential to minimize neurological risks and optimize outcomes.