The incidence and outcomes of vertebral column resection in paediatric patients

Helenius, Ilkka; Serlo, Joni; Pajulo, Olli

doi:10.1302/0301-620x.94b7.28545

Cited by 21 publications

(20 citation statements)

References 22 publications

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“…A limited number of studies comparing different spinal instrumentation techniques for severe scoliosis of 90° or more exists [3, 5, 7]. Additionally, some of these studies are purely register-based or multisurgeon, thus further decreasing the information available on the details of surgical techniques applied as well as complications after a 2-year follow-up.…”

Section: Introductionmentioning

confidence: 99%

Morbidity and radiographic outcomes of severe scoliosis of 90° or more: A comparison of hybrid with total pedicle screw instrumentation

Helenius

Mattila

Jalanko

2014

Journal of Children's Orthopaedics

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ObjectivesUntreated severe scoliosis is associated with increased mortality and remains a significant surgical challenge. Few studies have reported mortality after the surgical treatment of severe scoliosis beyond a 2-year follow-up. The objectives of this study were to evaluate mortality beyond standard 2-year follow-up and compare radiographic outcomes using hybrid or pedicle screw instrumentation for severe scoliosis.MethodsWe evaluated 32 consecutive patients [11 males, mean age at surgery 15.3 (range 10.7–20.7) years] operated for a scoliosis of 90° or more using either hybrid (n = 15) or pedicle screw (n = 17) instrumentation. The follow-up time averaged 2.9 (2.0–6.6) years for radiographic and quality of life measurements and 5.5 years (2.0–9.0) years for mortality data. Of these patients, one had adolescent idiopathic scoliosis, three secondary scoliosis, and 28 neuromuscular scoliosis. Twelve patients in the hybrid and two patients in the pedicle screw groups underwent anteroposterior surgery (p < 0.001), and three patients in both groups had an apical vertebral column resection.ResultsOne (3.1 %) patient died during follow-up for severe pneumonia. Preoperatively, the mean magnitude of the major curve was 109° (90°–127°) in the hybrid and 100° (90°–116°) in the pedicle screw groups (p = 0.015), and was corrected to 45° (19°–69°) in the hybrid and 27° (18°–40°) in the pedicle screw groups at the 2-year follow-up (p < 0.001), with a mean correction of the major curve of 59 % (37–81 %) in the hybrid versus 73 % (60–81 %) in the pedicle screw groups, respectively (p = 0.0023). There were six postoperative complications, including one transient spinal cord deficit necessitating reoperation in the hybrid group as compared with five complications in the pedicle screw group (p = 0.53).ConclusionsThe mid-term mortality rate after the surgical treatment of severe scoliosis was low. Severe scoliosis can be treated safely with significantly better correction of the spinal deformity using pedicle screws than hybrid instrumentation.

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Section: Introductionmentioning

confidence: 99%

Morbidity and radiographic outcomes of severe scoliosis of 90° or more: A comparison of hybrid with total pedicle screw instrumentation

Helenius

Mattila

Jalanko

2014

Journal of Children's Orthopaedics

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“…Кроме того, в двух случаях выявлены осложнения (проксимальный контактный кифоз и периимплантационная инфекция), потребовавшие ревизионных вмешательств. Helenius et al [12], проведя 4 операции VCR у детей с врожденными угловыми кифозами, наряду с кор-Рис. 1 Принципы коррекции кифоза: а -исходное состояние: кифотическая деформация на фоне разрушенной или гипоплазированной передней колонны позвоночника, прерывистой линией обозначена зона резекции, обеспечивающая переднюю мобилизацию позвоночника; б -винты межтелового дистрактора (стрелки), введенные в боковые поверхности тел позвонков; в -передняя инструментальная фиксация (двусторонняя стрелка) и передний межтеловой спондилодез; г -задняя инструментальная фиксация (прерывистые стрелки соответствуют направлению напряжения конструкции в режиме компрессии) ; б -интраоперационное увеличение диастаза с 10 до 24 мм дистрактором Caspar после резекции тел Th 4 -Th 7 ; в -рентгенограммы после операции: передний спондилодез Th 3 -Th 8 проведен титановым мешем с ауторебром с восстановлением физиологического профиля грудного отдела позвоночника до 44°; суммарная коррекция кифоза 36°Р ис.…”

Section: Discussionunclassified

Anterior correction of angular kyphosis in children: description of the technique and analysis of clinical series

et al. 2018

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Objective. To describe the original technical surgical procedure simplifying the correction of kyphosis in children due to instrumental distraction of the anterior column of the spine, to analyze its effectiveness in the setting of clinical series. Level of evidence – IV. Material and Methods. The study included 9 patients aged 7 months to 14 years (median age: 4 years 8 months) with angular kyphosis (median magnitude 53°, min – 38°, max – 80°) associated with tuberculous (n = 4) and non-specific (n = 4) spondylitis and with a sequelae of spinal cord injury (n = 1). Deformity correction was achieved using temporary instrumental interbody distraction followed by anterior fusion with titanium mesh cage filled with autologous bone graft during a single-step two-stage reconstruction and stabilization surgery. Results. The duration of surgery was 3 hours 2 min ± 44 min, the volume of blood loss – 190 ml ± 39 ml. In all cases, the deformity was corrected by 75–85 % with restoration of physiological thoracic kyphosis and spinal profile. Conclusion. A safe and effective technique for intraoperative anterior instrumental distraction can be used to correct angular kyphosis in children, including infants.

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“…The goal of treating kyphosis is to reestablish the sagittal profile through osteotomy procedures. When treating severe congenital angular kyphosis, it is essential to excise the apex of the kyphosis with VCR and to provide sufficient anterior support.…”

Section: Discussionmentioning

confidence: 99%

“…Posterior vertebral column resection (VCR) is the optimal procedure for correction of thoracolumbar angular kyphosis because it ensures maximal excision of deformity. However, because VCR interrupts the original continuity of the spine column, it renders the whole spine at risk of high instability; thus, neurological complications can and do occur.…”

Section: Introductionmentioning

confidence: 99%

Posterior Double Vertebral Column Resections Combined with Satellite Rod Technique to Correct Severe Congenital Angular Kyphosis

Sun

Zhu

Chen

et al. 2016

Orthopaedic Surgery

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This paper presents a highly challenging technique involving posterior double vertebral column resections (VCRs) and satellite rods placement. This was a young adult case with severe angular thoracolumbar kyphosis of 101 degrees, secondary to anterior segmentation failure from T11 to L1 . There were hemivertebrae at T11 and T12 , and a wedged vertebra at L1 . He received double VCRs at T12 and T11 and instrumented fusion from T6 to L4 via a posterior only approach. Autologous grafts and a cage were placed between the bony surfaces of the osteotomy gap. Once closure of osteotomy was achieved, bilateral permanent CoCr rods were placed with addition of satellite rods. Postoperative X-ray demonstrated marked correction of kyphosis. On the 10(th) days after surgery, the patient was able to walk without assistance. In conclusion, double VCRs are effective to correct severe angular kyphosis, and addition of satellite rods may be imperative to enhance instrumentation strength and thus prevent correction loss.

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The incidence and outcomes of vertebral column resection in paediatric patients

Cited by 21 publications

References 22 publications

Morbidity and radiographic outcomes of severe scoliosis of 90° or more: A comparison of hybrid with total pedicle screw instrumentation

Morbidity and radiographic outcomes of severe scoliosis of 90° or more: A comparison of hybrid with total pedicle screw instrumentation

Anterior correction of angular kyphosis in children: description of the technique and analysis of clinical series

Posterior Double Vertebral Column Resections Combined with Satellite Rod Technique to Correct Severe Congenital Angular Kyphosis

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