Wang Yingsong, Lu Ning, Zhang Ying, Liu Luping, Zhao Zhi, Yang Zhendong, Zhao Daohong, Chen Hong, Xie Jingming
Department of Orthopaedic Surgery, the Second Affiliated Hospital of Kunming Medical College, Kunming Yunnan, 650101, P.R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2010 Apr;24(4):424-9.
To discuss operative strategies of posterior deformity vertebra resection and instrumentation fixation in the treatment of congenital scoliosis or kyphoscoliosis in child and adolescent patients, and to evaluate the surgical results.
From May 2003 to December 2007, 28 patients with congenital scoliosis or kyphoscoliosis were treated with one stage posterior deformity vertebra resection. There were 11 males and 17 females with an average age of 9.6 years (1.5-17.0 years). The locations were thoracic vertebra in 13 cases, thoracolumbar vertebra in 10 cases, and lumbar vertebra in 5 cases. All the patients underwent one stage posterior deformity vertebra resection, fusion and correction with pedicle instrumentation. According to different types of deformities, the patients underwent three different surgeries: hemivertebra resection (13 patients), hemivertebra resection combined contralateral unsegmental resection (7 patients), and total vertebral column resection (8 patients). Based on short or long segmental pedicle instrumentation, deformities were corrected and fixed, in 7 patients with short segmental fixation (group A), in 13 patients with long segmental fixation with hemivertebra resection or combined contralateral unsegmental resection (group B), and in 8 patients with long segmental fixation with total vertebral column resection (group C). The operative duration and the volume of blood loss were recorded, and the correction rate was calculated through measurement of Cobb angles of scoliosis and kyphosis before and after operation.
The operation time of groups A, B, and C was (98 +/- 17), (234 +/- 42), and (383 +/- 67) minutes, respectively, and the blood loss during operation was (330 +/- 66), (1540 +/- 120), and (4760 +/- 135) mL, respectively; showing significant differences among three groups (P < 0.05). All patients achieved one-stage healing of incision. No deep infection, respiratory failure or deep vein thrombosis occurred. One patient had the signs of ischemical reperfusion injury of spinal cord 6 hours after operation and recovered after 2 weeks of relative therapy in group C; no neurological complication occurred in other patients. The mean follow-up period was 32.8 months (24-72 months). Intervertebral rigid fusion was identified from radiological data 6 months after operation according to contiguous callus crossed intervertebral gap and maintenance of correction results. No instrumentation failure occurred. There were significant differences in the Cobb angle between before and after operations (P < 0.01). There were significant differences in the corrective rate of scoliosis between groups A, B and group C (P < 0.05). Meanwhile, there were significant differences in the corrective rate of kyphosis between groups A, C and group B (P < 0.05).
One-stage posterior deformity vertebra resection has a good capability of correcting congenital scoliosis or kyphoscoliosis on coronal and sagittal plane relied on removal deformity origin. It is important to select appropriated strategies on deformity resection and segmental fixation according to different ages and deformity situations of patient.
