Radiologic Parameters Can Affect the Preoperative Decision Making of Three-Column Spinal Osteotomies in the Treatment of Severe and Stiff Kyphoscoliosis

Fan, Hengwei; Li, Xueshi; Huang, Zifang; Sui, Wenyuan; Yang, Jing; Deng, Yong; Wang, Chongwen; Lang, Chuandong; Yang, Junlin

doi:10.1097/brs.0000000000002210

Cited by 12 publications

(19 citation statements)

References 15 publications

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“…Severe spinal deformities require a higher osteotomy level. Our previous study also showed that the preoperative maximum kyphosis and S-DAR may affect the surgeon's decision regarding the osteotomy grade [21]. Kyphosis can easily cause a spinal cord injury during the operation, because: 1) the anterior spinal artery is easily affected; 2) the anterior horn of the spinal cord is easily compressed; 3) a high-grade osteotomy requires more anterior column manipulation; and 4) the anterior horn of the spinal cord is easily pulled and injured during the correction.…”

Section: Discussionmentioning

confidence: 97%

Risk factors for neurological complications in severe and rigid spinal deformity correction of 177 cases

et al. 2020

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Background Difficult procedures of severe rigid spinal deformity increase the risk of intraoperative neurological injury. Here, we aimed to investigate the preoperative and intraoperative risk factors for postoperative neurological complications when treating severe rigid spinal deformity. Methods One hundred seventy-seven consecutive patients who underwent severe rigid spinal deformity correction were assigned into 2 groups: the neurological complication (NC, 22 cases) group or non-NC group (155 cases). The baseline demographics, preoperative spinal cord functional classification, radiographic parameters (curve type, curve magnitude, and coronal/sagittal/total deformity angular ratio [C/S/T-DAR]), and surgical variables (correction rate, osteotomy type, location, shortening distance of the osteotomy gap, and anterior column support) were analyzed to determine the risk factors for postoperative neurological complications. Results Fifty-eight patients (32.8%) had intraoperative evoked potentials (EP) events. Twenty-two cases (12.4%) developed postoperative neurological complications. Age and etiology were closely related to postoperative neurological complications. The spinal cord functional classification analysis showed a lower proportion of type A, and a higher proportion of type C in the NC group. The NC group had a larger preoperative scoliosis angle, kyphosis angle, S-DAR, T-DAR, and kyphosis correction rate than the non-NC group. The results showed that the NC group tended to undergo high-grade osteotomy. No significant differences were observed in shortening distance or anterior column support of the osteotomy area between the two groups. Conclusions Postoperative neurological complications were closely related to preoperative age, etiology, severity of deformity, angulation rate, spinal cord function classification, intraoperative osteotomy site, osteotomy type, and kyphosis correction rate. Identification of these risk factors and relative development of surgical techniques will help to minimize neural injuries and manage postoperative neurological complications.

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Section: Discussionmentioning

confidence: 97%

Risk factors for neurological complications in severe and rigid spinal deformity correction of 177 cases

et al. 2020

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“…More recently, Rajasekaran et al 13 proposed a classification system for kyphosis based on column deficiency, curve magnitude, and osteotomy requirement. Fan et al 14 concluded that preoperative kyphosis, as well as the sagittal deformity angularity ratio, would guide the decision on the grade of osteotomies. The Kunming consensus stated that VCRs are indicated in severe (>90°), rigid (<20% flexible), and angular deformities 15 .…”

Section: Decision-making Among Osteotomiesmentioning

confidence: 99%

“…Although the decision-making algorithms 6,9,[13][14][15] are still valid, there is a global tendency toward avoiding 3COs as much as possible because of the growing evidence regarding the effectiveness of PCOs, and of the use of anterior column realignment and halogravity traction. Yet, there is a dearth of literature on the accurate identification of patients who can be treated successfully with the less invasive methods.…”

Section: Posterior Column Osteotomies Versus 3-column Osteotomiesmentioning

confidence: 99%

Osteotomies for the Treatment of Adult Spinal Deformities

et al. 2022

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Spinal osteotomies are powerful deformity correction techniques that may be associated with serious complications. » The anatomical spinal osteotomy classification system proposes 6 grades of resection corresponding to different anatomic bone, disc, facet, and ligament interventions. » Surgeons should be aware of the nuances of 3-column osteotomies with regard to spinal level selection, construct composition, and posterior column reconstruction and closure techniques.» There is a global tendency toward avoiding 3-column osteotomies as much as possible because of the growing evidence regarding the effectiveness of posterior column osteotomies and halo-gravity traction.

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“…Conventional correction techniques combined with threecolumn osteotomies, such as pedicle subtraction osteotomy (PSO), grade 4 spinal osteotomy (bone-disc-bone osteotomy, BDBO), vertebral column resection (VCR), and multilevel VCR, were commonly used in the treatment of severe and rigid kyphoscoliosis. [3][4][5][6] Circumferential VCR, and posterior VCR (PVCR) have been developed to correct severe and rigid spinal deformity. 7 Even though conventional correction techniques combined with three-column osteotomies were proved to be of excellent clinical outcomes in previous studies, [3][4][5][6][7] only two long rods are used to correct the severe deformities during conventional correction procedures, maintaining the coronal and sagittal alignment.…”

Section: Introductionmentioning

confidence: 99%

Sequential Correction versus Conventional Correction for Severe and Rigid Kyphoscoliosis: A Retrospective Case Control Study

Hua,

Ke,

et al. 2023

Orthopaedic Surgery

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ObjectiveConventional correction techniques were challenging and of high risk of neurological complications for the correction of severe and rigid kyphoscoliosis. A new technical note we developed and named as sequential correction, was used to treat severe and rigid kyphoscoliosis. The present study was to compare the clinical outcomes of sequential correction versus conventional correction for the treatment of severe and rigid kyphoscoliosis.MethodsThis is a respectively case–control study. Between January 2014 and December 2019, 36 adults underwent the surgical correction of severe and rigid kyphoscoliosis and were included in the present study. Among them, 20 adults underwent conventional correction, 16 adults underwent sequential correction. Major curve Cobb angle, kyphotic angle, coronal imbalance, and sagittal vertical axis were compared between two groups. The patient‐reported health‐related quality of life outcomes, including the Oswestry disability index score, and SRS‐22 questionnaire, were recorded. Independent samples t‐test, Mann–Whitney U test, and Wilcoxon signed‐rank test, were used to compare the differences between two groups according to the results of normal distribution test.ResultsIn conventional correction group, the mean major curve Cobb angle was 122.50° preoperatively, 40.35° immediately after surgery, and 43.95° at final follow‐up postoperatively; the mean kyphotic angle was 97.45° preoperatively, 34.45° immediately after surgery, and 38.30° at final follow‐up postoperatively. In the sequential correction group, the mean major angle was 134.44° preoperatively, 44.56° immediately after surgery, and 46.25° at final follow‐up postoperatively; the mean kyphotic angle was 112.31° preoperatively, 39.00° immediately after surgery, and 40.38° at final follow‐up postoperatively. The mean major curve Cobb angle and kyphotic angle of both groups were improved significantly, while there were no significant differences between two groups (p > 0.001). Improved self‐reported quality of life scores were achieved postoperatively and at final follow‐up postoperatively, and there were no significant differences between the two groups. The total complication rate of the patients underwent conventional correction was 55%, and the total complication rate of the patients underwent sequential correction was 43.75%. The complication rate of the two groups showed no significant difference.ConclusionsSequential correction is an excellent and safe treatment for severe and rigid kyphoscoliosis in adults, with similar clinical outcomes with conventional correction. The total complication rate of the patients who underwent sequential correction was slightly lower than conventional correction.

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Radiologic Parameters Can Affect the Preoperative Decision Making of Three-Column Spinal Osteotomies in the Treatment of Severe and Stiff Kyphoscoliosis

Abstract: 4.

Cited by 12 publications

References 15 publications

Risk factors for neurological complications in severe and rigid spinal deformity correction of 177 cases

Risk factors for neurological complications in severe and rigid spinal deformity correction of 177 cases

Osteotomies for the Treatment of Adult Spinal Deformities

Sequential Correction versus Conventional Correction for Severe and Rigid Kyphoscoliosis: A Retrospective Case Control Study

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