Mehdian Hossein, Arun Ranganathan, Aresti Nick A
Centre for Spinal studies and Surgery, D Floor, West Block, Queens Medical Centre, Derby Rd, Nottingham NG7 2UH, UK.
Barts Health, Royal London Hospital, Whitechapel Rd, London E1 1BB, UK.
Spine J. 2015 Apr 1;15(4):771-6. doi: 10.1016/j.spinee.2015.01.014. Epub 2015 Jan 19.
Fixed sagittal plane imbalance (FSI) has traditionally been corrected by either opening or closing wedge osteotomies or vertebral column resections. These methods involve multiple vertebrae and have been associated with limited degrees of correction and/or neurovascular compromise.
We describe a new V-Y vertebral osteotomy (VYO) that involves a single vertebra, allowing for correction of all three columns in a safer fashion.
A prospective assessment of the degree of correction pre- and post-VYO in a tertiary spinal center.
Ten consecutive patients presenting with sagittal plane imbalance were enrolled in this study.
Outcomes were assessed with pre- (preop) and postoperative (postop) outcome questionnaires (Oswestry Disability Index [ODI] and Scoliosis Research Society-24) and radiography.
Ten patients underwent VYO at L3 with varying levels of instrumentation. The procedure involves a V-shaped osteotomy in the sagittal plane, sparing the anterior 50% of the body, the apex of which is then converted to a Y shape, and the osteotomy closed.
Patients were followed for a mean of 36 months (24-48 months). The procedure led to significant improvements in sagittal balance, lumbar lordosis, thoracic kyphosis, coronal balance, sacral inclination, and pelvic incidence. The average degree of correction achieved was 44.58°±6.19° (mean±standard deviation). The mean blood loss was 1,287±350 mL and the operative time was 220±24 minutes. The mean preop ODI was 72% (range 58%-85%) and postop ODI averaged 22% (range 10%-30%). The mean preop SRS-24 score was 30.1 and postop was 101.
The VYO provides a safe correction of up to 45° at a single osteotomy site in FSI patients. It involves an isolated posterior approach and is recommended for corrections below the region of the conus.
传统上，固定矢状面失衡（FSI）通过开放或闭合楔形截骨术或脊柱切除术来矫正。这些方法涉及多个椎体，且与有限的矫正程度和/或神经血管损伤相关。
我们描述一种新的V-Y椎体截骨术（VYO），该手术仅涉及单个椎体，能够以更安全的方式矫正脊柱的三柱结构。
在一家三级脊柱中心对VYO术前和术后的矫正程度进行前瞻性评估。
本研究纳入了10例连续的矢状面失衡患者。
通过术前（术前）和术后（术后）结果问卷（Oswestry功能障碍指数[ODI]和脊柱侧弯研究学会-24）以及影像学检查来评估结果。
10例患者在L3行VYO手术，并采用不同程度的内固定。该手术在矢状面进行V形截骨，保留椎体前部50%，然后将截骨顶点转换为Y形，最后闭合截骨。
患者平均随访36个月（24 - 48个月）。该手术使矢状面平衡、腰椎前凸、胸椎后凸、冠状面平衡、骶骨倾斜度和骨盆入射角均有显著改善。平均矫正度数为44.58°±6.19°（平均值±标准差）。平均失血量为1287±350 mL，手术时间为220±24分钟。术前ODI平均为72%（范围58% - 85%），术后ODI平均为22%（范围10% - 30%）。术前SRS - 24评分平均为30.1，术后为101。
VYO在FSI患者的单个截骨部位可安全矫正高达45°。它采用单纯后路入路，推荐用于圆锥以下区域的矫正。
