Deformed Complex Vertebral Osteotomy Technique for Management of Severe Congenital Spinal Angular Kyphotic Deformity

Abstract

Objectives To (i) introduce the deformed complex vertebral osteotomy (DCVO) technique for the treatment of severe congenital angular spinal kyphosis; (ii) evaluate the sagittal correction efficacy of the DCVO technique; and (iii) discuss the advantages and limitations of the DCVO technique. Methods Multiple malformed vertebrae were considered a malformed complex, and large‐range and angle wedge osteotomy was performed within the complex using the DCVO technique. Patients with local kyphosis greater than 80° who were treated with DCVO and did not have tumors, infections, or a history of surgery were included. A retrospective case study was performed in these patients with severe angular kyphosis who underwent the DCVO technique from 2008 to 2016. Demographic data, the operating time, and the volume of intraoperative blood loss were collected. Spinopelvic parameters (pelvic incidence [PI], pelvic tilt [PT], and sacral slope [SS]), local and global sagittal parameters (deformity angle, thoracic kyphosis [TK], and lumbar lordosis [LL]), visual analog scale (VAS) score, and Oswestry disability index (ODI) score were recorded pre‐ and postoperatively. Paired t‐tests (α = 0.05) were used for all data (to compare the mean preoperative value with the mean postoperative and most recent follow‐up values). P < 0.05 was considered statistically significant. Results Twenty‐nine patients with a mean age of 34 years (range, 15–55) were included in the final analysis. Seventeen patients were male, and 12 were female. The mean follow‐up was 44 months (range, 26–62). The mean operating time was 299 min (range, 260–320 min). The mean blood loss was 2110 mL (range, 1500–2900 mL). Three patients had T7–T8 deformities (3/29, 10.3%), six had T8–T9 deformities (6/29, 20.7%), six had T9–T10 deformities (6/29, 20.7%), 10 had T10–T11 deformities (10/29, 34.5%), three had T11–T12 deformities (3/29, 10.3%), and one had T9–T11 deformities (1/29, 3.4%). The mean local deformity angle significantly improved from 94.9° ± 10.8° to 24.0° ± 2.3° through the DCVO technique, with no significant loss at the follow‐up. Moreover, the global sagittal parameters and spinopelvic parameters exhibited ideal magnitudes of improvement; TK decreased from 86.1° ± 12.1° to 28.7° ± 2.5°, LL improved from 94.5° ± 4.1° to 46.1° ± 3.0°, and PI minus LL improved from −60.9° ± 6.5° to −13.7° ± 2.6°. Both the VAS and ODI scores significantly improved at the last follow‐up. CSF fistula and neural injury did not occur during the perioperative period. At the last follow‐up, fixation failure was not observed. Conclusion The DCVO technique provides an alternative and effective method for the treatment of congenital severe angular spinal kyphotic deformities and may decrease the occurrence of perioperative complications.

Strategy and Efficacy of Surgery for Congenital Cervicothoracic Scoliosis with or without Hemivertebra Osteotomy

“…The hemivertebra was removed with a bone knife and other tools; the use of an ultrasonic bone knife can greatly reduce surgical trauma to soft tissue, especially nervous tissue and vascular tissue. For fully segmented hemivertebrae, the upper or lower endplates and intervertebral discs should be removed 12 . After completion of the osteotomy, the residual cavity was closed until the bone surface was closed, and pre‐shaped correction rods were inserted to complete the correction.…”

“…For fully segmented hemivertebrae, the upper or lower endplates and intervertebral discs should be removed. 12 After completion of the osteotomy, the residual cavity was closed until the bone surface was closed, and pre‐shaped correction rods were inserted to complete the correction. The fusion segments were at least two vertebrae above and below the hemivertebra.…”

Posterior-Only T11 Vertebral Column Resection for Pediatric Congenital Kyphosis Surgical Correction

“…These results mirror those of our surgical intervention. Another study [ 27 ] examined twenty-nine patients, and the mean local deformity angle notably improved from 94.9° to 24.0°, with no significant regression during follow-up. There were no instances of intraoperative or neural injury in the perioperative phase.…”

Retrospective analysis of deformed complex vertebral osteotomy in children with severe thoracic post-tubercular angular kyphosis

“…Therefore, when compared to PSO and VCR, the following characteristics and benefits of DCVO can be summarized [8][9][10][11][12][13][14][15][16][17][18][19][20]26]: (1) Deformed complex vertebrae usually involve two or more vertebral bodies and the partial or total fusion of many segments' facet joints and intervertebral discs. Multiple deformed and fused vertebrae were treated as a single unit, which simplified complicated problems and aided in developing a more specific osteotomy within the unit and precise positioning during surgery.…”

“…Deformed complex vertebrae indicated that multiple deformed and fused vertebrae were usually involved with two or more vertebral bodies and the partial or total fusion of many segments' facet joints and intervertebral discs [ 16 ]. The DCVO involves performing a larger posterior wedge-shaped and three-column osteotomy within deformed complex vertebrae using an ultrasonic scalpel, osteotomes, and high-speed drilling to correct a wider range of angles.…”