Sui Wen-Yuan, Huang Zi-Fang, Deng Yao-Long, Fan Heng-Wei, Yang Jing-Fan, Li Fo-Bao, Yang Jun-Lin
Department of Orthopaedic Surgery, The 1st Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.
Department of Orthopaedic Surgery, The 1st Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.
World Neurosurg. 2017 Aug;104:723-728. doi: 10.1016/j.wneu.2017.05.063. Epub 2017 May 19.
To assess the clinical and radiographic outcomes of posterior vertebral column resection (PVCR) without anterior support in treatment of Yang type A severe rigid thoracic kyphoscoliosis.
The records of 27 Yang type A severe thoracic kyphoscoliosis patients treated with PVCR without anterior support from January 2010 to September 2013 were analyzed retrospectively. Intraoperative multimodal neurophysiological monitoring was conducted in all patients. The 6 modes were somatosensory evoked potential, motor evoked potential, descending neurogenic evoked potential, spinal cord evoked potential, and electromyography (both triggered and free run). Radiographic parameters and complications were used to evaluate the clinical outcomes.
PVCR without anterior support was conducted successfully in all 27 patients. Intraoperative monitoring events occurred in 3 patients (3/27); of these, 1 patient (1/27) showed postoperative spinal cord injury, but completely recovered within 9 months after the operation (Frankel level E). The number and osteotomy space of vertebrae resection were mean 1.33 levels and 3.7 cm, respectively. All cases achieved good coronal and sagittal curve correction. No implant related complications occurred until the latest follow-up. The average follow-up was 40.1 months (range, 24-59 months).
In this study, we found that posterior vertebral column resection (PVCR) without any anterior support with a mean 3.7 cm shortening of the spinal column is safe, if close and unyielding contact of end plates can be obtained. A comprehensive understanding of the technique and intensive intraoperative neuromonitoring is mandatory to perform these challenging and complex spine deformity correction procedures safely.
评估无前路支撑的后路脊柱全椎体切除术（PVCR）治疗强直性脊柱炎A型严重僵硬型胸椎后凸畸形的临床和影像学效果。
回顾性分析2010年1月至2013年9月采用无前路支撑的PVCR治疗的27例强直性脊柱炎A型严重胸椎后凸畸形患者的病历。所有患者均进行术中多模式神经生理监测。监测模式包括体感诱发电位、运动诱发电位、下行神经源性诱发电位、脊髓诱发电位以及肌电图（触发式和自由运行式）。采用影像学参数和并发症评估临床疗效。
27例患者均成功实施了无前路支撑的PVCR。3例患者（3/27）术中出现监测事件；其中1例患者（1/27）术后发生脊髓损伤，但术后9个月内完全恢复（Frankel E级）。椎体切除的节段数和截骨间隙平均分别为1.33个节段和3.7 cm。所有病例在冠状面和矢状面均获得了良好的畸形矫正。直至最近一次随访，未发生与植入物相关的并发症。平均随访时间为40.1个月（范围24 - 59个月）。
在本研究中，我们发现，如果终板能够紧密且牢固接触，无任何前路支撑、平均脊柱缩短3.7 cm的后路脊柱全椎体切除术（PVCR）是安全的。要安全地实施这些具有挑战性和复杂性的脊柱畸形矫正手术，必须全面了解该技术并在术中进行严密的神经监测。
