FOCOS Orthopedic Hospital, No 8 Teshie Street, Pantang Accra, Ghana.
Centro de Tratamiento de Columna Vertebral CS, Madrid, Spain.
Spine Deform. 2021 Mar;9(2):411-425. doi: 10.1007/s43390-020-00179-1. Epub 2020 Nov 18.
Prospective case series OBJECTIVE: Results of surgical treatment of complex vertebral transposition "Gamma Deformity" > 180 degrees with halo gravity traction (HGT) and vertebral column resection (VCR). We recently published a novel classification system for complex spine deformities of which complex vertebral transposition > 180 degrees (Gamma; type 3) was described. Halo gravity traction (HGT) has been shown to mitigate surgical risk in complex spine deformity correction and in some cases obviates the need for three-column osteotomy. However, we are not aware of report of its utilization in treating Gamma deformities with or without vertebral column resection (VCR).
A consecutive series of 13 patients with Gamma deformity (GD) were prospectively enrolled at a single site in West Africa. Standard radiographs and 3D computerized tomography (CT) were done to assess coronal and sagittal vertebral transposition (CVT and SVT). The HGT with 50% of body weight was applied over several weeks followed by VCR. Demographics, operative data, radiographic parameters, and complications data were collected.
13 pts with GD underwent HGT for an avg of 110 days prior to definitive surgery. Etiologies were Congenital-11 pts and Neurofibromatosis-2 pts. Average age: 17.8 years; Pts were reviewed at 3 months post-op and at minimum 2-year follow-up. Preop myelopathy was present in five patients. Pre-op CVT avg 75% and was corrected in all cases post-op. SVT avg 211 deg and improved with HGT by 36% and corrected to 53 deg (74% correction) post-op. Thoracic kyphosis avg -42 deg and averaged 48 deg post-op. Intra-op spinal cord monitoring (SCM) alerts occurred in 8 pts (61%). Post-operative LEM deficits occurred in 5 pts: 2 fully recovered by 3 months and 2 year follow-up, while the remaining 3 improved but had residual motor deficits at final follow-up. There was one post-operative mortality.
The management of complex vertebral transposition (Gamma deformity) > 180 degrees with HGT prior to VCR is not only effective in some patients, but also associated with high SCM alerts and neurologic injury rates. Myelopathic patients with thoracic deformities are at higher risk of developing permanent neurologic deficits. Surgeons should be aware of this rare and unusual deformity and consider HGT and VCR bearing in mind the technical challenges and high complication rate.
前瞻性病例系列
报道复杂脊柱换位“伽玛畸形”> 180 度的手术治疗结果，该手术采用 halo 重力牵引（HGT）和脊柱切除术（VCR）。我们最近发表了一种新的复杂脊柱畸形分类系统，其中描述了复杂脊柱换位> 180 度（伽玛；3 型）。HGT 已被证明可降低复杂脊柱畸形矫正的手术风险，并且在某些情况下可避免三柱截骨术。然而，我们不知道在治疗伴有或不伴有脊柱切除术（VCR）的伽玛畸形时使用 HGT 的报道。
在西非的一个单一地点，前瞻性地连续纳入了 13 例伽玛畸形（GD）患者。进行标准的 X 线和三维计算机断层扫描（CT）检查以评估冠状位和矢状位椎体移位（CVT 和 SVT）。HGT 施加 50%的体重，持续数周，然后进行 VCR。收集人口统计学、手术数据、影像学参数和并发症数据。
13 例 GD 患者接受 HGT 治疗，平均时间为 110 天，然后进行确定性手术。病因是先天性 11 例，神经纤维瘤病 2 例。平均年龄：17.8 岁；术后 3 个月和至少 2 年随访时进行检查。术前存在 5 例脊髓病。术前 CVT 平均为 75%，术后均得到纠正。SVT 平均为 211 度，HGT 后改善 36%，术后矫正为 53 度（74%矫正）。胸椎后凸平均为-42 度，术后平均为 48 度。8 例（61%）患者术中发生脊髓监测（SCM）警报。术后 LEM 缺陷发生在 5 例患者中：2 例在 3 个月和 2 年随访时完全恢复，而另外 2 例有残留运动缺陷。有 1 例术后死亡。
在 VCR 之前使用 HGT 治疗复杂的椎体换位（伽玛畸形）> 180 度不仅在某些患者中有效，而且还与高 SCM 警报和神经损伤发生率相关。伴有胸脊柱畸形的脊髓病患者发生永久性神经功能缺损的风险更高。外科医生应了解这种罕见和不寻常的畸形，并考虑 HGT 和 VCR，同时要考虑到技术挑战和高并发症发生率。
