Loss of Correction After Vertebrectomy for Treatment of Spinal Deformities

Abstract

Objective: To evaluate the loss of correction after treatment of spine deformities with the technique of isolated posterior vertebrectomy. Methods: Twenty-one patients were followed-up for three years after surgery with panoramic X-rays, CT scans, SF-36 and Oswestry questionnaires. We evaluated the loss of correction, CAGE subsidence and the evolution of the pelvis-T1 angle during follow-up. The correlation among the radiographic changes and functional and quality of life scores was also assessed. Results: All patients had some degree of loss of correction and subsidence of CAGE, especially in the first year of follow-up. Such losses exerted negative impact on the function, pain and self-image of the patients. Factors such as the stiffness of the fusion mass and size of implant used appear to have contributed to the occurrence of subsidence, regardless of age and bone mineral density. Conclusions: The use of spacers with larger cross-sectional diameter and more rigid rods can reduce the overloading on the anterior column of Denis, reducing the subsidence and loss of correction. Additional stabilization strategies such as the use of orthoses postoperatively can also be useful, and should be evaluated in subsequent studies.

Mechanical Complications and Loss of Correction in Osteotomies of the Three Columns

“…2,4 Their use is only justified because sagittal correction is of great importance in the context of adult deformities, since it has been shown that pain and disability are directly related to an increased SVA and changes in sagittal spinopelvic parameters. [13][14][15] When considering a three-column osteotomy, the decision making process should take the possibility of not achieving sufficient correction or of having postoperative loss of correction into account, [5][6][7][8] since the procedure is subject to various complications and mechanical failures, and may also be impacted by reinterventions that may occur. 16 However, this point is addressed by few articles, which usually originate in centers of excellence where osteotomy procedures have been developed and perfected, and it is not reasonable to expect the technique to spread to smaller centers.…”

“…[2][3][4] Their use is justified by the importance of sagittal correction in surgeries for deformity, but few articles describe how much of this correction is maintained because of complications that occur and the duration of follow-up in these cases. 5,6 This study surveys the mechanical complications and the evolution of sagittal spinopelvic measurements of a series of 20 patients with sagittal imbalance who underwent three-column osteotomies with follow-up for at least one year.…”