All Pedicle Screw Fixation Technique in Correcting Severe Kyphoscoliosis in an Osteogenesis Imperfecta Patient

Abstract

Spinal deformity in patients with osteogenesis imperfecta demonstrates a high prevalence. The surgical treatment of this problem had numerous difficulties, which included breakage of bone, dislodgement of implants, and late loss of correction. We reported the correction of severe kyphoscoliosis in a patient with osteogenesis imperfecta using 3-rod all pedicle screw fixation technique. In this case, the 2 main goals of spinal operation, stabilization and correction of spinal curvatures, were achieved. The Cobb angles of scoliosis and thoracic kyphosis were corrected from 110 degrees to 68 degrees and from 107 degrees to 39 degrees, respectively. One and a half years after the operation, spinal radiographs showed no loss of correction, either on coronal or sagittal planes. The predicted forced vital capacity, predicted forced expiratory volume in 1 second and vital capacity of the lung of the patient had improved 2-fold. The usage of pedicle screw, with its conical core and cylindrical thread design, and 3-rod technique in fixation, together with cyclic intravenous bisphosphonate administration and halo-gravity traction preoperatively, contributed to the success in this case.

Scoliosis and Kyphosis in Osteogenesis Imperfecta

“…Possible surgical complications include breakage of lamina or pedicles by implants, inability to instrument spine due to severe osteoporosis, instrumentation failure postoperatively resulting in loss of correction, late pseudoarthrosis and excessive blood loss. 41,43 A combination of the techniques covered in the preceding paragraphs may prove to be the most effective treatment strategy to avoid complications. This is best exemplified by a case presented by Pan et al The patient had type IV OI and significant kyphoscoliosis, with an upper curve of 110°, a lower curve of 65° and a thoracic kyphosis of 107°.…”

“…Correction also resulted in a significant improvement in pulmonary function. 41 In summary, abnormalities may exist at any level of the spine in patients with OI. Periodic history and physical examination will guide the imaging and appropriate conservative treatment under the care of an experienced physician who carries the picture of the whole patient in mind.…”

“…As correction of deformity varies significantly with disease severity, the main goal of treatment is the support and stabilization of the scoliotic spine. 41 Current techniques include posterior fusion with segmental pedicle screw instrumentation, using appropriately sized rods and screws. 24,41,42 Additionally, some surgeons have advocated partially correcting severe curves with halo-gravity traction prior to posterior fusion in order to minimize stress exerted on implants.…”

“…41 Current techniques include posterior fusion with segmental pedicle screw instrumentation, using appropriately sized rods and screws. 24,41,42 Additionally, some surgeons have advocated partially correcting severe curves with halo-gravity traction prior to posterior fusion in order to minimize stress exerted on implants. 43 Although these techniques are fairly straightforward in idiopathic scoliosis patients, the unique anatomy of OI patients can provide technical challenges.…”

Spinal Fractures, Spondylolysis and Spondylolysthesis

“…31 Segmental fixation has improved as has the strength of the bone in these individuals as a result of treatment with bisphosphonates, which may improve the stability and effectiveness of fixation in these patients. 15,16,32 However, there is no clear-cut guidance from the literature as to how to approach these individuals, who do require operative treatment for their fractures. …”