Orthopedic Spinal Surgery Unit 1, Bor-deaux Pellegrin Hospital, Bordeaux cedex, France.
Department of Orthopaedic Sur-gery, State University of New York, Down-state Medical Center, Brooklyn, New York.
Oper Neurosurg (Hagerstown). 2018 May 1;14(5):515-523. doi: 10.1093/ons/opx158.
Thoracic hyperkyphosis can display pathological deterioration, resulting in either hyperlordotic cervical compensation or sagittal malalignment. Various techniques have been described to treat fixed malalignment. Pedicle subtraction osteotomy (PSO) is commonly used in the lumbar spine and frequently limited to the distal thoracic spine. This series focuses on the surgical specificities of proximal thoracic PSO, with clinical and radiological outcomes.
To report the surgical specificities and assess the clinical and radiological outcomes of proximal thoracic osteotomies for correction of rigid kyphotic deformities.
This is a retrospective review of 10 consecutive patients who underwent single level proximal thoracic PSO (T2-T5). Preoperative and postoperative full-body EOSTM radiographs, perioperative data, and complications were recorded. The surgical technique and its nuances were described in detail.
Patients had mean age of 41.8 yr and 50% were female. The technique provided correction of segmental and global kyphosis, 26.6° and 29.5°, respectively. Patients reported reciprocal reduction in C2-C7 cervical lordosis (37.6°-18.6°, P < .001), significantly correlating with the reduction of thoracic hyperkyphosis (R = 0.840, P = .002). Mean operative time was 291 min, blood loss 1650 mL, and mean hospital stay was 13.8 d. Three patients reported complications that were resolved, including 1 patient who was revised because of a painful cross link. There were no neurological complications, pseudarthroses, instrumentation breakage, or wound infections at a minimum of 2-yr follow-up.
Proximal thoracic PSO can be a safe and effective technique to treat fixed proximal thoracic hyperkyphosis leading to kyphosis reduction and craniocervical relaxation.
胸椎过度后凸可导致病理性恶化，导致颈椎过度前凸代偿或矢状面失平衡。已经描述了各种技术来治疗固定性失平衡。椎弓根切除截骨术（PSO）常用于腰椎，并经常限于远段胸椎。本系列重点介绍了治疗僵硬后凸畸形的近端胸椎 PSO 的手术特点，包括临床和影像学结果。
报告近端胸椎截骨术治疗僵硬后凸畸形的手术特点，并评估其临床和影像学结果。
这是对 10 例连续接受单节段近端胸椎 PSO（T2-T5）治疗的患者进行的回顾性研究。记录术前和术后全身 EOSTM 射线照片、围手术期数据和并发症。详细描述了手术技术及其细节。
患者平均年龄为 41.8 岁，50%为女性。该技术提供了节段性和整体后凸的矫正，分别为 26.6°和 29.5°。患者报告 C2-C7 颈椎前凸（37.6°-18.6°，P<.001）的逆性减少，与胸椎后凸的减少显著相关（R=0.840，P=0.002）。平均手术时间为 291 分钟，失血量为 1650 毫升，平均住院时间为 13.8 天。3 例患者报告了并发症，这些并发症得到了解决，包括 1 例因交叉链接疼痛而进行了修正的患者。在至少 2 年的随访中，没有发生神经并发症、假关节、器械断裂或伤口感染。
近端胸椎 PSO 是一种安全有效的治疗固定性近端胸椎后凸的技术，可导致后凸减少和颅颈放松。
