Posterior three-column osteotomies for the treatment of rigid thoracic kyphosis – a case series

Abstract

ObjectiveTo evaluate the results and complications of a series of patients who underwent three-column osteotomy using the posterior approach for correction of complex cases of rigid dorsal kyphotic deformity.MethodsReview of clinical records and images of 15 consecutive cases of pedicle subtraction osteotomies, bone-disk-bone osteotomies, or vertebral column resection, recording the etiology, type and level of osteotomy, extension of fixation, complications, and pre- and post-surgical measurements of the sagittal curves and pelvic parameters.ResultsSix pedicle subtraction osteotomies were performed, one of which in two adjacent vertebrae, as well as two bone-disk-bone osteotomies and seven vertebral column resection, two of which were performed in two adjacent vertebrae. The mean correction was 39.3° for the angular kyphosis and 33.9° for dorsal kyphosis. The corrections were similar regardless of the kind of osteotomy, the operated spinal segment, or the approach in one or two levels, but this may be a sample effect.Eight complications were observed in six patients (40% of cases): two medical complications, five early and one late surgical complication (over 90 days after surgery). There were three reoperations within less than one year from the initial surgery and one case of persistent paraparesis. Clinical complications were resolved without sequelae. There was no significant loss of correction during the segment, except in two cases of major mechanical failure due to a junctional segment fracture.ConclusionDespite being complex and aggressive procedures, prone to various complications, osteotomies with resection of the three columns are highly effective in the correction of rigid kyphotic deformities and safe enough to justify its use in selected cases.

Comparison of the Curative Efficacy of Hemivertebra Resection via the Posterior Approach Assisted With Unilateral and Bilateral Internal Fixation in the Treatment of Congenital Scoliosis

“…According to the relationship between hemivertebrae and upper and lower vertebrae, CS can be divided into three types: fully segmented hemivertebra, partially segmented hemivertebra, and non-segmented hemivertebra (1,2). CS deformity in children is complex and even serious at birth, and develops continuously with growth; therefore, most scholars advocate early surgical treatment to block the progress of spinal deformity (3,4). Surgical treatment methods include in situ fusion, convex epiphyseal block, hemivertebra resection, and spinal fusion.…”

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

“…17 Although classical articles show local mobilizations of 30 to 40º with pedicle subtraction, in multicenter studies the average for the same procedure is only 22º. Previous observations 19 have shown that in osteotomies performed in patients with dorsal spine pathologies and compensated overall balance, corrections tend to be maintained, such that in this series we opted to use a worse scenario and include only imbalanced patients. Although an SVA above 5cm is defined as imbalance, some authors treat an SVA up to 8cm as acceptable.…”