Department of Pediatric Orthopaedic Surgery, Children's Mercy Hospital, Kansas City, MO, USA.
Department of Pediatric Orthopaedic Surgery, Cincinnati Children's Hospital, Cincinnati, OH, USA.
Spine Deform. 2024 Mar;12(2):403-410. doi: 10.1007/s43390-023-00775-x. Epub 2023 Oct 27.
Vertebral column resection (VCR) is a powerful corrective technique for the management severe, rigid spinal deformities but does carry a relatively high complications rate. One of the feared complications is pseudarthrosis which places the patient at risk for implant failure. We present a single-center experience with post-operative computed tomography (CT) imaging at the osteotomy site to screen for impending pseudarthrosis.
A retrospective review of a single surgeon series of posterior-only VCR performed for severe pediatric and adolescent spinal deformities was performed. Demographic, radiographic, and clinical data were collected. Patients underwent postoperative CT imaging at the osteotomy site 6-9 months following VCR with grading of the osteotomy fusion. Patients with impending pseudarthrosis were recommended for prophylactic revision surgery.
Thirty-three patients were included (mean age 11.6 ± 4.9 years, 54.5% female), undergoing a mean 1.9 level VCR. Kyphoscoliosis accounted for 75.7% (N = 25/33) of cases with 45.5% of all cases being congenital etiology and 60.6% having at least 1 previous surgery. Postoperative CT imaging was performed in 22 patients at a mean of 7.8 months following VCR. Two patients were identified as having impending pseudarthrosis with one undergoing revision surgery to enhance the posterior fusion, with addition of a third rod while one patient refusing surgery who subsequently developed broken hardware requiring revision surgery. No patient with a stable fusion on CT imaging developed a clinically significant pseudarthrosis.
Postoperative CT imaging of the osteotomy is useful in screening for impending pseudarthrosis and can aide in decision making for clearance to return to activity or the need for prophylactic intervention following VCR in pediatric and adolescent patients. We advocate that obtaining routine CT imaging of the osteotomy site at 6-9 months may identify potential complications earlier and allow for prophylactic intervention.
脊柱切除术（VCR）是一种强大的矫正技术，可用于治疗严重、僵硬的脊柱畸形，但也存在相对较高的并发症发生率。其中一种可怕的并发症是假关节形成，这会使患者面临植入物失败的风险。我们报告了一个单中心的经验，即对接受后路 VCR 的严重儿童和青少年脊柱畸形患者，在术后进行术区 CT 成像以筛查潜在的假关节形成。
对一位外科医生进行的后路 VCR 治疗严重儿童和青少年脊柱畸形的系列回顾性研究进行了回顾性分析。收集了人口统计学、影像学和临床数据。术后 6-9 个月，所有患者在 VCR 后都在术区进行 CT 成像，并对骨切开融合进行分级。对有潜在假关节形成的患者建议进行预防性翻修手术。
共纳入 33 例患者（平均年龄 11.6±4.9 岁，54.5%为女性），平均行 1.9 个节段 VCR。脊柱后凸侧凸占 75.7%（N=25/33），45.5%的病例为先天性病因，60.6%的病例至少有 1 次既往手术史。22 例患者在 VCR 后平均 7.8 个月进行了术后 CT 成像。2 例患者被确定为有潜在的假关节形成，其中 1 例患者接受了翻修手术以增强后路融合，并增加了第 3 根棒，而 1 例患者拒绝手术，随后出现了内固定物断裂，需要进行翻修手术。在 CT 成像上融合稳定的患者均未发生临床显著的假关节形成。
术后骨切开术区 CT 成像有助于筛查潜在的假关节形成，并有助于在儿童和青少年患者接受 VCR 后，决定是否可以恢复活动或是否需要预防性干预。我们主张在术后 6-9 个月常规对术区进行 CT 成像，这可以更早地发现潜在的并发症，并进行预防性干预。
