Faundez A, Byrne F, Sylvestre C, Lafage V, Cogniet A, Le Huec Jean-Charles
Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland.
Eur Spine J. 2015 Jan;24 Suppl 1:S42-8. doi: 10.1007/s00586-014-3658-3. Epub 2014 Nov 20.
Pedicle subtraction osteotomy is a well-described surgical technique for treatment of kyphotic deformity in the spine. It is not widely used for treatment of thoracic kyphosis. We present the first documented series of 28 patients who underwent this procedure in 3 international centers. These patients presented with severe deformity with a wide range of aetiologies.
Kyphosis larger than 70 degrees, which is demonstrably rigid based on dynamic imaging.
28 patients underwent surgery following pre-op neurological and radiographic assessment to fully assess the deformity. A triangular osteotomy was carried out using intraoperative navigation techniques. The patients were assessed post-operatively again with clinical and radiographic parameters at regular follow-up.
The mean ODI score after surgery was 24.7 (16-42) while the pre-op was 53.4 (38-76). Mean thoracic kyphosis was improved from 64.2° (±20.1°) to 41.1° (±17.4°) resulting in a mean sagittal correction of 23.1°. Mean segmental correction at the PSO for all 28 cases was 17.8° (±8.1°). Stratified by region we found different values for the PSO correction: between T1 and T5 (6 cases) it was 17.5° (±5.4°) and between T6 and T9 (4 cases) 18.2° (±4.7°) and between T10 and L1 (18 cases) 26.2° (±5.2°). FBI index was 22.3° pre-op and improved to 7.8° post-op. Calculations were performed with Microsoft excel (2011 Microsoft, Redmond, WA).
Global sagittal balance was statistically improved in this series as demonstrated by FBI and C7 SVA correction.
椎弓根截骨术是一种已被充分描述的用于治疗脊柱后凸畸形的外科技术。它在治疗胸段脊柱后凸方面并未得到广泛应用。我们展示了在3个国际中心接受该手术的28例患者的首个有记录的系列病例。这些患者表现出严重畸形，病因多种多样。
后凸大于70度，基于动态成像显示明显僵硬。
28例患者在术前进行神经学和影像学评估以全面评估畸形后接受手术。使用术中导航技术进行三角形截骨。术后定期随访时再次通过临床和影像学参数对患者进行评估。
术后平均ODI评分为24.7（16 - 42），而术前为53.4（38 - 76）。平均胸段后凸从64.2°（±20.1°）改善至41.1°（±17.4°），矢状面平均矫正23.1°。28例患者在椎弓根截骨术处的平均节段矫正为17.8°（±8.1°）。按区域分层，我们发现椎弓根截骨术矫正值不同：在T1和T5之间（6例）为17.5°（±5.4°），在T6和T9之间（4例）为18.2°（±4.7°），在T10和L1之间（18例）为26.2°（±5.2°）。术前FBI指数为22.3°，术后改善至7.8°。计算使用Microsoft excel（2011 Microsoft，华盛顿州雷德蒙德）进行。
如FBI和C7 SVA矫正所示，该系列病例的整体矢状面平衡在统计学上得到改善。
