Spinal osteotomy techniques in management of severe pediatric spinal deformity and analysis of postoperative complications.

STUDY DESIGN

Retrospective analysis.

OBJECTIVE

To compare radiographical analysis and clinical outcomes of spinal osteotomy techniques, including Smith-Petersen osteotomy (SPO), pedicle subtraction osteotomy (PSO), and vertebral column resection (VCR), and analyze the relationship between preoperative evaluation and postoperative complication incidence.

SUMMARY OF BACKGROUND DATA

These 3 techniques have been extensively reported previously, whereas, few literatures are available on comparing these 3 techniques in management of severe pediatric spinal deformity.

METHODS

In all the 34 pediatric patients, 14 were treated with SPO, 12 were treated with PSO, and 8 were treated with VCR. All operations were performed by the senior author (L. X.) between 2005 and 2009 in the Institute of Spinal Deformity, The First Affiliated Hospital of Zhengzhou University. Preoperative Halo-gravity traction was applied for 2 weeks in all patients; patients were evaluated by using standing radiographs taken before and after traction and after operation and a prospectively collected database with outcomes questionnaires. The postoperative complications and its relationship to preoperative assessment were also analyzed in this study.

RESULTS

All the 34 patients' severe pediatric spinal deformity (22 females and 12 males) was diagnosed, with an average age of 11.97 years (range, 6-17 yr) and an average follow-up of 66.38 months (range, 48-97 mo). The mean preoperative major curve for each group was 103.43º in the SPO group, 108.08º in the PSO group, and 117.00º in the VCR group, and was corrected to 15.21º, 16.83º, and 25.88º, respectively. The apical vertebral translation was corrected by 73.29% by SPO, 73.35% by PSO, and 59.71% by VCR. The coronal balance was improved from 16.57 mm to 1.50 mm in the SPO group, 17.33 mm to 3.83 mm in the PSO group, and 29.38 mm to 3.63 mm in the VCR group. The mean correction of the kyphotic angle for single SPO was 19.00º, for those with 2 and 3 SPOs, the average correction was 34.40º and 47.5º, and 33.83º for the PSO group, 47.38º for the VCR group. There were significant improvements in the overall clinical outcomes. The overall complication rate was 35.3%. The complication rate was high in patients with respiratory insufficiency and rigid spine.

CONCLUSION

There was no significant difference in coronal correction among these 3 techniques, whereas, the average corrections in the sagittal plane were progressively higher from single SPO to 2 SPOs or PSO to 3 SPOs or VCR. Preoperative respiratory insufficiency and rigidity of the spinal deformity are associated with a high complication rate.

LEVEL OF EVIDENCE