Expanded eggshell procedure combined with closing-opening technique (a modified vertebral column resection) for the treatment of thoracic and thoracolumbar angular kyphosis

Abstract

<jats:sec> <jats:title>OBJECT</jats:title> <jats:p>The purpose of this study was to determine the efficacy of a modified vertebral column resection for the treatment of thoracolumbar angular kyphosis.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>A total of 13 patients (8 male, 5 female) with thoracolumbar kyphosis (kyphotic angle &gt; 60°) were included in this study (Group A). There were 3 patients with failure of spinal formation (Type 1 deformity), 6 patients with old thoracic or lumbar compression fracture, and 4 patients with old spinal tuberculosis (including 1 case of T3–5 vertebral malunion). The average preoperative kyphotic angle was 67.3° (range 62°–75°). Each patient underwent an expanded eggshell procedure combined with the closing-opening technique for the treatment of thoracolumbar angular kyphosis. Sixteen patients who were previously treated with a closing-opening wedge osteotomy in the same spine classification group (kyphotic angle &gt; 60°) were used as a control group (Group B).</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>In Group A, the average (± SD) operative time was 400 ± 60 minutes, and the average blood loss was 960 ± 120 ml. There were no surgery-related complications observed during or after the operations. The average local kyphotic angle was 20.3° (range 18°–24.5°), and the average correction rate was 68.7%. In Group B, the average operative time was 470 ± 90 minutes, and the average blood loss was 2600 ± 1600 ml (range 1200–8200 ml). There were segmental vessels and spinal canal venous plexus injury in 1 case, spinal cord injury in 1 case, dural tearing in 2 cases, pleural rupture in 2 cases, and hemothorax and pneumothorax in 1 case. Each patient had more than 2 years of follow-up. At the latest follow-up examination, the average regional kyphotic angle was 19.9° ± 9.1° (range 19°–34°), and there was no significant loss of correction (p &gt; 0.05). There was greater blood loss and a higher complication rate in Group B than in Group A (p &lt; 0.05).</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>An expanded eggshell procedure combined with the closing-opening technique for the treatment of thoracolumbar angular kyphosis resulted in significant reduction of the kyphotic angle, few complications, and good follow-up results. However, a larger series of patients and long-term follow-up results is still required to verify the effectiveness and safety of this method.</jats:p></jats:sec>

Modified mini-open SRS-Schwab grade 4 osteotomy combined with percutaneous pedicle screws fixation in post-traumatic thoracolumbar kyphosis

“…The authors reported an expanded eggshell procedure, which combined with a closing-opening technique to treat thoracic and thoracolumbar angular kyphosis [10]. In this series, based on eggshell procedure, a modified Schwab grade 4 osteotomy technique was used with satisfactory clinical results.…”

“…Then, a posterior midline incision (5-8 cm) was made to expose the lamina and spinous process of the affected level. The grade 4 osteotomy with egg-shell technique was performed in a similar way as previously described [10]. Briefly, after removing the spinous process and lamina, the left pedicle was exposed and decancellated by a high-speed drill.…”

“…The main surgical methods for kyphosis correction include pedicle subtraction osteotomy (PSO), Smith-Petersen osteotomy (SPO), vertebral column resection (VCR), closing-opening wedge osteotomy (COWO), and vertebral column decancellation [1][2][3][4][5][6][7][8][9][10]. Schwab et al [11] classified spinal osteotomy technique into 6 grades according to the osteotomy site: grade 1 is partial facet joint resection such as SPO osteotomy; grade 2 is complete facet joint resection such as Ponte osteotomy; grade 3 is pedicle and partial body resection such as PSO; grade 4 is pedicle, partial body, and disc resection; grade 5 is complete vertebra and disc resection such as VCR and grade 6 is multiple adjacent vertebrae and disc resection.…”

“…The affected vertebral body's shape is usually like a trapezoid or triangle (lower height at the anterior vertebral body), which makes it easier to remove the upper level intervertebral disc and cancellous bone of the vertebral body through the pedicle. Combined with egg-shell technique, the risk of neurological injury and blood loss during the grade 4 osteotomy procedure can be further reduced [10].…”

Comparison of Clinical and Radiological Improvement Between the Modified Trephine and High-speed Drill as Main Osteotomy Instrument in Pedicle Subtraction Osteotomy

“…Severe thoracolumbar kyphosis may develop secondary to fracture, healed tuberculous infection, and congenital malformation. 1 – 5 Irrespective of the etiology, the rigid kyphotic deformity requires surgical intervention to prevent progressive deterioration in sagittal imbalance and in neurologic function. 6 – 9 Pedicle subtraction osteotomy (PSO), first described by Thomson, is an effective method for correcting the kyphotic deformity, and about 30° correction can be achieved by osteotomy at 1 level.…”