Sze Chia-Hung, Smith June C, Luhmann Scott J
Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S Euclid Ave., St. Louis, MO 63110, USA.
Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S Euclid Ave., St. Louis, MO 63110, USA.
Spine Deform. 2018 Nov-Dec;6(6):656-661. doi: 10.1016/j.jspd.2018.03.004.
In spinal deformity surgery, posterior column osteotomies (PCOs) are used to increase spinal flexibility and permit greater deformity correction, while avoiding the morbidity of anterior column surgery. Complications related to use of PCOs have been well characterized in adults; however, there is a paucity of information in the pediatric population.
A single-surgeon retrospective analysis was completed of 484 PCOs in 142 patients (average age: 14.5 years) undergoing spinal deformity surgery. All surgeries were completed by a standard posterior approach using a midline incision and dual-rod, pedicle screw constructs. PCO-related complications were recorded (intraoperative monitoring alerts, postoperative neurologic deficit, dural tear/violations, cerebrospinal fluid [CSF] leak, pseudarthrosis, etc.) and analyzed by diagnosis (idiopathic, congenital, neuromuscular, syndromic).
The diagnoses for the 142 patients were idiopathic (103 patients), neuromuscular (23 patients), syndromic (14 patients), and congenital (2 patients). In a subset of 87 patients with 2-year radiographic follow-up, the preoperative major coronal Cobb measurement was 75.5° ± 17.6°, which corrected to 34.9° ± 17.5° postoperatively and 37.8° ± 17.9° at last follow-up (p < .0001, p < .0001). Complications evaluated were postoperative neurologic deficit (0% of patients, 0/142), dural tears/violations at site of PCO (0.4% of PCOs, 2/484), CSF leak (0% of patients, 0/142), and pseudoarthrosis at site of PCO (0% of PCOs, 0/290).
The overall frequency of complications related to PCOs was 0.4% (0.4% dural tears/violations) with 0% postoperative neurologic deficit, CSF leak, or pseudarthrosis. Based on these data, PCOs appear to be a safe technique in pediatric spine deformity surgery, with a low rate of technique-related complications.
Retrospective case series.
To report the frequency of posterior column osteotomy complications (neurologic deficit, dural tear, cerebrospinal fluid leak, and pseudarthrosis) in pediatric patients undergoing spinal deformity surgery.
Level IV.
在脊柱畸形手术中，后柱截骨术（PCOs）用于增加脊柱柔韧性并实现更大程度的畸形矫正，同时避免前路手术的并发症。与PCOs使用相关的并发症在成人中已有充分描述；然而，儿科人群中的相关信息较少。
对142例接受脊柱畸形手术患者（平均年龄：14.5岁）的484次PCOs进行了单术者回顾性分析。所有手术均采用标准后路入路，经中线切口并使用双棒、椎弓根螺钉结构完成。记录与PCO相关的并发症（术中监测警报、术后神经功能缺损、硬脊膜撕裂/侵犯、脑脊液[CSF]漏、假关节形成等），并按诊断类型（特发性、先天性、神经肌肉性、综合征性）进行分析。
142例患者的诊断类型为特发性（103例）、神经肌肉性（23例）、综合征性（14例）和先天性（2例）。在87例有2年影像学随访的患者亚组中，术前冠状面Cobb角主要测量值为75.5°±17.6°，术后矫正至34.9°±17.5°，末次随访时为37.8°±17.9°（p<.0001，p<.0001）。评估的并发症包括术后神经功能缺损（患者比例0%，0/142）、PCO部位的硬脊膜撕裂/侵犯（PCOs比例0.4%，2/484）、CSF漏（患者比例0%，0/142）以及PCO部位的假关节形成（PCOs比例0%，0/290）。
与PCOs相关的并发症总发生率为0.4%（硬脊膜撕裂/侵犯0.4%），术后神经功能缺损、CSF漏或假关节形成的发生率为0%。基于这些数据，PCOs在儿童脊柱畸形手术中似乎是一种安全的技术，技术相关并发症发生率较低。
回顾性病例系列。
报告接受脊柱畸形手术的儿科患者后柱截骨术并发症（神经功能缺损、硬脊膜撕裂、脑脊液漏和假关节形成）的发生率。
IV级。
