Non-instrumented correction of cervicothoracic kyphosis in ankylosing spondylitis: a critical analysis on the results of open-wedge osteotomy C7-T1 with gradual Halo-Thoracic-Cast based correction

Abstract

With the non-instrumented HTC-based technique, average CBVA correction of 25° was achieved and all patients were ambulatory at follow-up. However, regarding translation at the osteotomy, loss of correction, morbidity of the HTC and lack of control at the osteotomy instrumentation-based correction and instrumented fusion seem to be preferable.

Three-column osteotomies of the lower cervical and upper thoracic spine: comparison of early outcomes, radiographic parameters, and peri-operative complications in 48 patients

“…Catastrophic neurologic injury is the most feared complication of cervicothoracic osteotomies. While the risk of paralysis was higher with Urist's extension osteotomy [24], neurologic complications remain the most common complication (13.5 %) for cervical kyphotic deformity correction despite advances in surgical techniques, instrumentation, and approaches [23]. One that deserves attention is a C8 radiculopathy, which is associated with both extension and closing wedge osteotomies at the CTJ as a result of iatrogenic foraminal stenosis [3,6,8,[23][24][25].…”

Characteristics of deformity surgery in patients with severe and rigid cervical kyphosis (CK): results of the CSRS-Europe multi-centre study project

“…These results compare well with previous studies published on the correction on rigid CK. Regional radiographic correction reported averaged 20°-25° in a series on OWO [44] with average 37° CVBA-correction [37]. Mehdian [45] reported on CBVA-angle correction of 47° in a series of 12 AS patients using OWO.…”

“…SVT at the osteotomy site can cause instability and poses a risk for neurologic structures [28,44,45,61,62] and was observed in 27-44% in previous CK studies [20,44,63]. SVT is the result of advanced correction, eccentric force application, non-physiologic angulation, and the difficulty to concentrate corrective forces at a single COR [20].…”

“…Surgical correction of rigid adult thoracolumbar deformities [64] and CK is challenged by the potential for a significant number of complications. In cervical deformity surgery, major complications were reported in 24-60% including neurologic complications in 7-25% [1,44,65]. Complication rates with cervical 3CO can be as high as 60% with reoperation rates of 33% [1] and the rate of severe neurologic deficits can be as high as 17-19% [1,44].…”

Aktuelle operative Therapiekonzepte zur Behandlung von Wirbelsäulendeformitäten bei Morbus Bechterew

“…Die ventral öffnende Osteotomie (opening-wedge) der LWS wurde erstmals von Smith Petersen beschrieben (Reprint aus dem Jahr 1945 in [12]), die zervikale Opening-Wedge-Osteotomie erstmals in einem Fallbericht von Mason [13] und später von Urist und Simmons modifiziert. Heutige Osteotomietechniken unterscheiden sich durch die instrumentierte Korrektur und sind den früheren Verfahren v. a. hinsichtlich Vermeidung von Translation und Korrekturverlust überlegen [14]. Aktuelle Klassifikationen für die verschiedenen Osteotomietechniken der Wirbelsäule existieren für die thorakolumbale [15] und die zervikothorakale [16] Region.…”