Scoliosis Research Society-Schwab Grade 6 Osteotomy for Severe Congenital Angular Kyphoscoliosis: An Analysis of 17 Cases With a Minimum 2-Year Follow-up

Shi, Bo; Shi, Benlong; Liu, Dun; Li, Yang; Xia, Sanqiang; Sun, Xu; Liu, Zhen; Qian, Bangping; Zhu, Zezhang; Qiu, Yong

doi:10.1093/neuros/nyaa055

Cited by 6 publications

(6 citation statements)

References 26 publications

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“…The mean Cobb angle of the main curve and horizontal distance between the C7 plumb line and central sacral vertical line were 96.1° 16.7°and 40. 4 (P < 0.001), with no evidence of correction loss during follow-up (P < 0.05). Patients with type 3 spinal cord exhibited a larger Cobb angle of the main curve than those with type 1 or 2 spinal cord (P < 0.001).…”

Section: Resultsmentioning

confidence: 94%

“…The correction rate has significantly improved in the last decades due to the broader adoption of the three-column osteotomy (3CO). [1][2][3][4] However, the prospect of neurological deficits following these surgeries remains a significant concern. Previous studies have reported relatively high incidences (ranging from 9.9% to 17.4%) of neurological deficits during 3CO, [5][6][7][8] highlighting the need for a precise risk assessment.…”

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confidence: 99%

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Assessing Neurological Complications in Thoracic Three-Column Osteotomy

Lo,

Shi,

Lin

et al. 2024

Spine

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Study Design: Retrospective comparative study. Objective: To investigate the occurrence of neurologic complications in patients undergoing thoracic three-column osteotomy (3CO) utilizing an MRI-based classification that assesses spinal cord shape and the presence of cerebrospinal fluid (CSF) at the curve apex, and evaluate its prognostic capacity for postoperative neurologic deficits. Summary of Background Data: Recent advancements in correction techniques have improved outcomes for severe spinal deformity patients undergoing 3CO. A novel MRI-based spinal cord classification system was introduced, but its validation and association with postoperative complications remain unexplored. Materials and Methods: Between September 2012 and September 2018, a retrospective analysis was conducted on 158 adult patients with spinal deformities undergoing 3CO. Radiographic parameters were measured. T2-weighted axial MRI was employed to describe spinal cord morphology at the apex. Intraoperative neurophysiologic monitoring (INOM) alerts were recorded, and preoperative and postoperative neurologic functions were assessed using the Frankel score. Categorical data were compared using the Chi-Square or Fisher’s exact test. The paired t-test was utilized to assess the mean difference between pre- and postoperative measurements, while the one-way ANOVA and independent t-test were employed for comparative analyses among the different spinal cord types. Results: Patients were categorized into three groups: type 1, type 2, and type 3, consisting of 12, 85, and 61 patients. Patients with type 3 morphology exhibited larger Cobb angles of the main curve (P<.001). This disparity persisted both postoperatively and during follow-up (P<.05). IONM alerts were triggered in 32 patients (20.3%), with a distribution of one case in type 1, six cases in type 2, and 22 cases in type 3 morphologies (P<.001). New neurologic deficits were observed in 15 patients (9.5%), with one, three, and 11 cases in type 1, 2, and 3 morphologies, respectively. Conclusions: Patients with type 3 morphology exhibited greater spinal deformity severity, higher likelihood of preoperative neurologic deficits, and an elevated risk of postoperative neurologic complications. This underscores the utility of the classification as a tool for predicting postoperative neurologic complications in patients undergoing thoracic 3CO. Level of Evidence: Level IV.

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Section: Resultsmentioning

confidence: 94%

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confidence: 99%

Assessing Neurological Complications in Thoracic Three-Column Osteotomy

Lo,

Shi,

Lin

et al. 2024

Spine

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“…In the severe group, the average Cobb angle decreased from 104° to 33°, and the correction rate was up to 67%. Shi et al 16 also found a 65% correction rate in the treatment of severe scoliosis with the VCR technique. In addition to the surgery-only strategy, several researchers applied preoperative traction with posterior surgical correction.…”

Section: Discussionmentioning

confidence: 95%

Preoperative Halo-Femoral Traction With Posterior Surgical Correction for the Treatment of Extremely Severe Rigid Congenital Scoliosis (Cobb Angle >120°)

Zhang

Yang

Guo

et al. 2022

J Am Acad Orthop Surg

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Introduction:To evaluate the effectiveness and safety of preoperative halo-femoral traction (HFT) with posterior surgical correction for the treatment of extremely severe rigid congenital scoliosis (>120°).Methods:We reviewed the records of all patients with extremely severe rigid congenital scoliosis (>120°) treated with preoperative HFT from 2010 through 2018. Radiographic measurements were performed. The period of traction, blood loss, operation time, complications, and pulmonary function test results were recorded.Results:A total of 11 patients were included in the study. All patients underwent preoperative HFT with posterior surgical correction. The mean preoperative main curve Cobb angle was 127.9° ± 4.4°, and the average correction rate was 33.5% posttraction, 54.8% postoperation, and 55.3% at the latest follow-up. Pulmonary function improved significantly after traction, and forced vital capacity and forced expiratory volume in 1 second increased from 34.7% and 33.4% to 48.1% and 48.5%, respectively. Only one patient experienced halo pin infection during HFT. No patients experienced permanent neurologic deficits or death.Conclusion:For extremely severe rigid congenital scoliosis with a Cobb angle greater than 120°, preoperative HFT with posterior surgical correction offers an effective and safe corrective option. The perioperative complication rate can be partially reduced.Study Design:Retrospective study.

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“…The authors concluded that most patients would show varying degrees of IONM loss with the VCR procedure almost complete. Shi et al 12 reported 17 patients with severe congenital angular kyphoscoliosis undergoing multiple VCRs, and the alarming changes in IONM were detected in 4 patients (23.5%) during osteotomy. In the current study, the total incidence of IONM alters was 17.8% (98 of 551 patients) including 82 SEP alerts and 91 MEP alerts, which was slightly lower than the data from studies mentioned above.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Neurophysiological Monitoring Alerts During Three-Column Osteotomy: Incidence and Risk Factors

Liu

Qiu²,

Zhu³

et al. 2022

Journal of Clinical Neurophysiology

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Prupose: To analyze the incidence and risk factors of intraoperative neurophysiological monitoring (IONM) alerts in patients undergoing three-column osteotomy.Methods: A total of 551 patients (340 males and 211 females) with an average age of 31.9 years undergoing posterior 3-column osteotomy were retrospectively reviewed. The coronal Cobb angle of main curve and sagittal global kyphosis were measured on preoperative standing whole spinal x-rays. The Frankel scores at preoperation, postoperation, and the last follow-up were recorded and applied for assessment of neurologic status. Surgical procedures and other factors associated with IONM alerts were analyzed.Results: A total of 98 (17.8%) IONM alerts were reported during surgery, including 82 somatosensory evoked potential alerts and 91 motor evoked potential alerts. Positive wake-up test was revealed in 57 patients (10.3%) even after prompt managements, and new neurologic deficits were observed in 50 patients (9.1%) at immediate postoperation. Of the 50 patients with new neurologic deficits at postoperation, the Frankel scores were A in 5 patients, B in 4, C in 9, and D in 32. The x 2 test showed that patients with congenital deformities, global kyphosis .908, vertebral column resection procedure, cervicothoracic/thoracic osteotomy, blood loss .3,000 mL, and preoperative neurologic deficit were at a higher risk of IONM alerts. Conclusions:The incidence of IONM alerts in patients undergoing 3-column osteotomy was 17.8%. Congenital deformities, global kyphosis .908, vertebral column resection, cervicothoracic/thoracic osteotomy, blood loss .3,000 mL, and preoperative neurologic deficit indicated high risk of IONM alerts.

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Scoliosis Research Society-Schwab Grade 6 Osteotomy for Severe Congenital Angular Kyphoscoliosis: An Analysis of 17 Cases With a Minimum 2-Year Follow-up

Cited by 6 publications

References 26 publications

Assessing Neurological Complications in Thoracic Three-Column Osteotomy

Assessing Neurological Complications in Thoracic Three-Column Osteotomy

Preoperative Halo-Femoral Traction With Posterior Surgical Correction for the Treatment of Extremely Severe Rigid Congenital Scoliosis (Cobb Angle >120°)

Intraoperative Neurophysiological Monitoring Alerts During Three-Column Osteotomy: Incidence and Risk Factors

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