Spine Surgery Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
Clinique du Dos, Elsan Jean Villar Private Hospital, Bordeaux, France.
Eur Spine J. 2023 May;32(5):1800-1809. doi: 10.1007/s00586-023-07650-3. Epub 2023 Mar 20.
Different techniques have been previously described to close the pedicle subtraction osteotomy (PSO) site for correction of sagittal malalignment; the use of a side-to-side domino connector as a correction tool in the thoracic spine has not been specifically studied.
Twenty adult patients who underwent single-level thoracic PSO from T1 to T12 were included and retrospectively reviewed (two centers). Preoperative and postoperative full-body X-rays, perioperative data, clinical data and complications were recorded with a minimum 2 years of follow-up. Surgical technique and the nuances in using the domino connector were described in detail.
Patients had a mean age of 40y; 40% were female. Two different techniques involving the domino were applied for closure of the PSO site depending on the type of kyphosis (smooth vs. angular deformity). Both techniques provided significant correction of the local kyphosis (from 48° to 18°) with reciprocal reduction of compensatory cervical lordosis (from 37.6° to 18.6°, p < 0.01) in upper thoracic PSO or lumbar lordosis (from 74.5° to 46.6°, p < 0.01) in lower thoracic PSO. Four patients presented postoperative complications that resolved (hemothorax, GI bleeding), and two patients presented transient neurological deficit. Oswestry Disability Index score improved in the majority of the patients (from 32.7 to 22.5, p < 0.05). There were no pseudarthroses, symptomatic instrumentation breakage, or surgical site infection.
Use of a side-to-side domino connector in combination with two different rod cantilever techniques is effective for the reduction of thoracic pedicle subtraction osteotomy achieving satisfactory radiological and clinical outcome.
先前已经描述了多种技术来闭合经椎弓根楔形截骨术（PSO）部位以矫正矢状面失平衡；尚未专门研究将侧对侧 Domino 连接器用作胸椎矫正工具。
回顾性纳入了在两个中心接受单节段胸段 PSO（T1 至 T12）的 20 例成年患者。记录了术前和术后全身 X 线片、围手术期数据、临床数据和并发症，随访时间至少 2 年。详细描述了手术技术和 Domino 连接器的使用要点。
患者平均年龄为 40 岁；40%为女性。根据后凸类型（平滑性与角状畸形），采用两种不同的 Domino 技术闭合 PSO 部位。两种技术均显著矫正了局部后凸（从 48°至 18°），并相应减少了颈椎代偿性前凸（从 37.6°至 18.6°，p<0.01）（在上胸段 PSO）或腰椎前凸（从 74.5°至 46.6°，p<0.01）（在下胸段 PSO）。4 例患者出现术后并发症（血胸、胃肠道出血），均已解决；2 例患者出现短暂性神经功能缺损。大多数患者的 Oswestry 功能障碍指数评分均得到改善（从 32.7 分至 22.5 分，p<0.05）。无假关节形成、症状性器械断裂或手术部位感染。
侧对侧 Domino 连接器结合两种不同的棒悬臂技术可有效减小胸段 PSO，获得满意的影像学和临床结果。
