Apex of deformity for three-column osteotomy. Does it matter in the occurrence of complications?

Sacramento-Dominguez, Cristina; Yagi, Mitsuru; Ayamga, Jennifer; Nemani, Venu M.; Akoto, Harry; Mahmud, Rufai; Wulff, Irene; Gupta, Munish C.; Papadopoulos, E.; Pellisé, Ferràn; Sanchez-Perez-Grueso, Francisco; Hess, W. Fred; Kim, Hee Jin; Hodes, Richard M.; Boachie-Adjei, Oheneba

doi:10.1016/j.spinee.2015.07.010

Cited by 10 publications

(4 citation statements)

References 11 publications

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“…Las complicaciones posoperatorias inmediatas más comunes son las respiratorias, como neumonías, derrame pleural, atelectasias. Las complicaciones mayores en este tipo de cirugías oscilan entre el 17% y el 70,6%, 13,16,[18][19][20] el 8-35% son complicaciones neurológicas. Nuestro paciente no sufrió complicaciones mayores en el posoperatorio, ni secuelas neurológicas.…”

Section: Discussionunclassified

Cifoescoliosis severa secundaria a neurofibromatosis. Presentación de un caso

Alvarado

Vásquez

Falcon³

2020

Rev. Asoc. Arg. Ort. y Traumatol

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La escoliosis distrófica de la neurofibromatosis se caracteriza por ser una cifoescoliosis de ángulo agudo que compromete un segmento corto de la columna vertebral y genera una gran deformidad que, sumada a los cambios distróficos de la columna, convierte a los gestos quirúrgicos para su corrección en verdaderos retos. Se presenta a un varón de 15 años con cifoescoliosis toracolumbar distrófica severa con ápice en T9, ángulo de Cobb 107° de escoliosis y 110,7° de cifosis segmentaria. Se realiza una cirugía por vía posterior en tres tiempos, mediante una resección de la columna vertebral y reemplazo con malla de titanio; se logra una corrección de la cifosis y la escoliosis del 56% y 59,8%, respectivamente. El paciente no tuvo complicaciones mayores, ni secuelas, y la evolución fue favorable. La resección de la columna vertebral es una técnica quirúrgica potente y desafiante para el manejo de la deformidad cifoescoliótica compleja necesaria para lograr el equilibrio espinal, aunque no está exenta de complicaciones, sobre todo neurológicas y pulmonares, a veces, inevitables. La calidad de vida de nuestro paciente tuvo una mejoría importante. Palabras clave: Neurofibromatosis; escoliosis; resección; columna vertebral.Nivel de Evidencia: IV

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Section: Discussionunclassified

Cifoescoliosis severa secundaria a neurofibromatosis. Presentación de un caso

Alvarado

Vásquez

Falcon³

2020

Rev. Asoc. Arg. Ort. y Traumatol

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“…Several recent articles have demonstrated that PVCR may lead to major complications, especially neurological injuries. 3 , 31 , 32 For example, Wang et al 31 evaluated the efficacy and safety of PVCR for 24 patients with congenital SAK. These patients had an average segmental kyphosis 87.3° preoperatively.…”

Section: Discussionmentioning

confidence: 99%

“…Four patients (17%) faced major complications (neurological deficit about 8%) postoperatively. Another study performed by Sacramento-Domínguez et al 32 showed that PVCR was performed on 98 patients with complex spinal deformity that have various etiologies and average localized kyphosis 104° preoperatively. Major complications occurred in 46 patients (47%) (neurologic in 25 patients (25.5%)) postoperatively.…”

Section: Discussionmentioning

confidence: 99%

Analysis of complications following posterior vertebral column resection for the treatment of severe angular kyphosis greater than 100°

Atıcı

Balioğlu²,

Kargın³

et al. 2017

Acta Orthopaedica et Traumatologica Turcica

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ObjectiveThe aim of this study was to evaluate the complications, efficacy and safety of posterior vertebral column resection (PVCR) in severe angular kyphosis (SAK) greater than 100°.MethodsThe medical records of 17 patients (mean age 17.9 (range, 9–27) years) with SAK who underwent PVCR, were reviewed. Mean follow-up period was 32.2 (range, 24–64) months. Diagnosis of the patients included congenital kyphosis in 11 patients, post-tuberculosis kyphosis in 3 patients and neurofibromatosis in 3 patients. The sagittal plane parameters (local kyphosis angle, lumbar lordosis, sagittal vertical axis, pelvic tilt, sacral slope and pelvic incidence) were measured in the preoperative and the early postoperative periods and during the last follow-up on the lateral radiographs.ResultsThe mean preoperative localized kyphosis angle was 121.8° (range, 101°–149°). The mean local kyphosis angle (LKA) was 71.5° at postoperatively evaluation (p < 0.05). Complications were detected in 12 patients (70.6%) with spinal shock in 4 patients, hemothorax in 3 patients, postoperative infection in 2 patients, dural laceration in 2 patients, neurological deficit in 2 patients (1 paraplegia and 1 root injury), the shifted cage in 2 patients and rod fracture in 2 patients. Neurological events occurred in six patients (35%) with temporary neurological deficit in 5 patients and permanent neurological deficit in 1 patient.ConclusionPVCR is an efficient and a successful technique for the correction of SAK. However, it can lead to a large number of major complications in SAK greater than 100°.Level of evidenceLevel IV, therapeutic study.

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“…Das Komplikationsrisiko ist bei Patienten mit Myelopathie, intraspinaler Anomalie (Syrinx, Split-Cord), neuromuskulärer Grunderkrankung und Syndromerkrankungen, bei Kyphosen und Skoliosen > 90°, bei Revisionseingriffen sowie auch Patienten mit schwerer restriktiver Ventilationsstörung signifikant erhöht [2, 4 -7]. Das Risiko eines neurologischen Defizits steigt nicht nur mit dem Ausmaß der Deformität, sondern auch mit der Lokalisation des Apex der Deformität [8]. Für VCR-Eingriffe wurde in unabhängigen Literaturübersichten die Rate postoperativ neuer neurologischer Defizite mit ca.…”

Section: Häufigkeitenunclassified

Neuro-vaskuläre Komplikationen bei komplexen Korrektureingriffen − Ursachen, Prävention, Systemlösungen

et al. 2019

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ZusammenfassungDie Autoren präsentieren eine ausführliche Übersichtsarbeit, welche Einblicke in die Pathogenese, Prävention und Therapie neurovaskulärer Komplikationen in der Behandlung komplexer spinaler Pathologien ermöglicht. Insbesondere werden die strategischen Grundzüge für die Vermeidung neurologischer Läsionen bei Patienten mit komplexen Deformitäteneingriff an der Wirbelsäule und mit neurologische erhöhten Risiko dargestellt.

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Apex of deformity for three-column osteotomy. Does it matter in the occurrence of complications?

Cited by 10 publications

References 11 publications

Cifoescoliosis severa secundaria a neurofibromatosis. Presentación de un caso

Cifoescoliosis severa secundaria a neurofibromatosis. Presentación de un caso

Analysis of complications following posterior vertebral column resection for the treatment of severe angular kyphosis greater than 100°

Neuro-vaskuläre Komplikationen bei komplexen Korrektureingriffen − Ursachen, Prävention, Systemlösungen

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