Lumbar Osteotomy Techniques

Nazar, Ryan; Gum, Jeffrey L.; Dimar, John R.; Djurasovic, Mladen

doi:10.1007/978-3-319-59713-3_22

Cited by 1 publication

(2 citation statements)

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“…17 Many different types of osteotomies have been described. 18 Among these, it is possible to manage moderate deformities with PCOs alone, 19 but for more severe curves, more invasive osteotomies may be necessary. Ozturk et al 10 reported good short term results for PVCR in severe, rigid and neglected congenital spinal deformities defined as curves with < 30% flexibility and a magnitude of more than 50 degrees on the TruGA; however, PVCR remains a technically challenging, resource-intensive technique that has long surgical times, great amounts of blood loss and the potential for devastating complications.…”

Section: Discussionmentioning

confidence: 99%

“…Spinal osteotomies, despite increasing complication rates and morbidity, are often unavoidable in severely rigid curves for adequate correction 17. Many different types of osteotomies have been described 18. Among these, it is possible to manage moderate deformities with PCOs alone,19 but for more severe curves, more invasive osteotomies may be necessary.…”

Section: Discussionmentioning

confidence: 99%

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Posterior Instrumentation and Fusion in Multiple-segment Adolescent Congenital Scoliosis: When Are Posterior Column and Concave Rib Osteotomies Needed?

Yücekul

Ramazanov

Olgun

et al. 2021

Journal of Pediatric Orthopaedics

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Background: No clear guidelines exist for appropriate surgical treatment of congenital scoliosis. The spectrum varies from isolated posterior instrumentation and fusion (PIF-only) to vertebral column resections. Multiple posterior column osteotomies (PCOs) with and without concave rib osteotomies have previously been suggested as an alternative to invasive 3-column osteotomies. The aim of the study is to analyze outcomes of spinal surgery in congenital scoliosis patients for a new treatment algorithm based on a traction radiograph under general anesthesia (TruGA). Methods: Surgical intervention was determined according to flexibility with TruGA: patients with > 40% correction underwent PIF-only; patients with < 40% of correction underwent PCO. Patients, who had < 30% of correction in TruGA and/or more than 5 vertebral levels with failure of segmentation, underwent additional concave rib osteotomies. The radiologic and clinical results were compared. Results: Forty-three patients met inclusion criteria (14M). The mean age was 13.8 (10 to 17) years, average follow-up 67 (24 to 107) months. Fourteen patients were in the PIF-only group, 29 in the PCO group. PCO patients were significantly older (14.5 vs. 12.3, P = 0.001). Mean operative time and blood loss of PCO group were significantly greater than those of PIF-only group. Nine patients required concave rib osteotomies. While the curve magnitude of patients in the PIF-only and PCO groups did not differ significantly (54.6 vs. 63 degrees, P = 0.067), curve rigidity was significantly higher in the patients of PCO group (51.2% vs. 32%, P = 0.001). Despite this, postoperative correction rates for 2 groups were similar (51.1% vs. 47.8%, P = 0.545). Conclusions: The number of anomalous segments and the curve flexibility on TruGA play important roles in the decision-making process in congenital scoliosis and < 40% flexibility of the major curve could be an important indicator of the need for PCO. Curves with more than 5 anomalous vertebral segments might be more likely to need additional concave rib osteotomies for adequate correction. Level of Evidence: Level III.

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