Osteotomies/spinal column resections in adult deformity

WOS: 000316140200018PubMed ID: 22576156Osteotomies may be life saving procedures for patients with rigid severe spinal deformity. Several different types of osteotomies have been defined by several authors. To correct and provide a balanced spine with reasonable amount of correction is the ultimate goal in deformity correction by osteotomies. Selection of osteotomy is decided by careful preoperative assessment of the patient and deformity and the amount of correction needed to have a balanced spine. Patient's general medical status and surgeon's experience levels are the other factors for determining the ideal osteotomy type. There are different osteotomy options for correcting deformities, including the Smith-Petersen osteotomy (SPO), pedicle subtraction osteotomy (PSO), bone-disc-bone osteotomy (BDBO) and vertebral column resection (VCR) providing correction of the sagittal and multiplanar deformity. SPO refers to a posterior column osteotomy in which the posterior ligaments and facet joints are removed and a mobile anterior disc is required for correction. PSO is performed by removing the posterior elements and both pedicles, decancellating vertebral body, and closure of the osteotomy by hinging on the anterior cortex. BDBO is an osteotomy that aims to resect the disc with its adjacent endplate(s) in deformities with the disc space as the apex or center of rotational axis (CORA). VCR provides the greatest amount of correction among other osteotomy types with complete resection of one or more vertebral segments with posterior elements and entire vertebral body including adjacent discs. It is also important to understand sagittal imbalance and the surgeon must consider global spino-pelvic alignment for satisfactory long-term results. Vertebral osteotomies are technically challenging but effective procedures for the correction of severe adult deformity and should be performed by experienced surgeons to prevent catastrophic complications

Posterior Vertebral Column Resection in Severe Spinal Deformities A Total of 102 Cases

WOS: 000287446300008PubMed ID: 21325930Study Design. Retrospective case series. Objective. To analyze the efficacy and safety of posterior vertebral column resection (PVCR) performed to a consecutive series of patients with severe spinal deformity and managed by PVCR. Summary of Background Data. The treatment of severe spinal deformities is a demanding and difficult surgical challenge. Conventional procedures such as posterior and anterior instrumentation or combined anteroposterior instrumentation afford limited correction in rigid neglected or maltreated (fused) deformities. Methods. A total of 102 consecutive patients with severe deformity and managed by PVCR between years 1996 and 2007 having more than 2 years follow-up were included. Mean age was 37.6 (range = 2-84 years) years at the time of operation. The hospital charts were reviewed for demographic data and etiology of deformity. Measurements of curve magnitude and balance were made on 36-inch standing anteroposterior and lateral radiographs taken before surgery and at most recent follow-up to assess deformity correction, spinal balance, complications related to the instrumentation, and any evidence of pseudarthrosis. Results. Preoperative coronal plane major curve of 102 degrees (range = 80 degrees-29 degrees) with flexibility of less than 30% was corrected to 38.3 degrees (range = 20 degrees-72 degrees) showing a 62% scoliosis correction at the final follow-up. Coronal imbalance was improved 72% at the most recent follow-up assessment. Preoperative thoracic kyphosis of 83 degrees (range = 65 degrees-104 degrees) in patients with kyphosis was corrected to 36 degrees (range = 25 degrees-48 degrees) at the most recent follow-up evaluation. Lumbar lordosis of 25 degrees (range = 8 degrees-35 degrees) in patients with hypolordotic deformity was corrected to 42 degrees. Two patients had nerve root palsies not identified during the surgery and healed completely in 6 months after surgery. Conclusion. PVCR is an effective technique because it is a spinal column shortening procedure and it allows to do correction in same session. However, it is a technically demanding procedure with possible risks for major complications

Simultaneous surgical treatment in congenital scoliosis and/or kyphosis associated with intraspinal abnormalities

WOS: 000251442600015PubMed ID: 18246012Study Design. Retrospective clinical study. Objective. To show retrospective analysis of 21 consecutive patients who underwent simultaneous surgical treatment for progressive spinal deformity and coexisting intraspinal pathologies (tethered cord and/or diastematomyelia). Summary of Background Data. The classic advocated approach in patients with congenital spine deformity associated with intraspinal anomalies is first to perform surgery for the intraspinal pathologies and then surgery for correction and stabilization of the deformity 3 to 6 months later. To our knowledge, there is no study on simultaneous surgical treatment for these 2 associated conditions. Methods. In the surgery; after the exposure of the determined levels, placement of all pedicle screws was performed as the initial part of surgical procedure. Then surgical treatment for intraspinal pathology was performed by the neurosurgical team and then followed by completion of instrumentation and correction of the deformity. Additional anterior surgery was done later to prevent pseudarthrosis and crankshaft phenomenon. Results. The mean age of the patients at presentation ranged from 3 to 19 years (mean, 13 years). There were 17 female patients and 4 male patients. Four patients had neurologic deficits at the time of presentation, and all 4 had associated kyphosis. The mean operation time was 9.3 hours (range, 7-12 hours) and the mean blood loss was 1980 mL (range, 1500-3000 mL). The average follow-up was 6.8 years (2-12 years). None of the patients experienced deterioration in their neurologic status after surgery. None of the patients had infection, pseudarthrosis, or loss of correction during the follow-up visits. Conclusion. The simultaneous surgical treatment for congenital deformity and intraspinal abnormality does not involve significant complications and seems to be an alternative and safe treatment option