Posterior multilevel vertebral osteotomy for correction of severe and rigid neuromuscular scoliosis

A preliminary study

Seung-Woo Suh, Hitesh N. Modi, Jaehyuk Yang, Hae Ryong Song, Ki-Mo Jang

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

STUDY DESIGN. Prospective study. OBJECTIVE. To determine the effectiveness and correction with posterior multilevel vertebral osteotomy in severe and rigid curves without anterior release. SUMMARY OF BACKGROUND DATA. For the correction of severe and rigid scoliotic curve, anterior-posterior combined or posterior vertebral column resection (PVCR) procedures are used. Anterior procedure might compromise pulmonary functions, and PVCR might carry risk of neurologic injuries. Therefore, authors developed a new technique, which reduces both. METHODS. Thirteen neuromuscular patients (7 cerebral palsy, 2 Duchenne muscular dystrophy, and 4 spinal muscular atrophy) who had rigid curve >100° were prospectively selected. All were operated with posterior-only approach using pedicle screw construct. To achieve desired correction, posterior multilevel vertebral osteotomies were performed at 3 to 5 levels (apex, and 1-2 levels above and below apex) through partial laminotomy sites connecting from concave to convex side, just above the pedicle; and repeated cantilever manipulation was applied over temporary short-segment fixation, above and below the apex, on convex side. On concave side, rod was assembled with screws and rod-derotation maneuver was performed. Finally, short-segment fixation on convex side was replaced with full-length construct. Intraoperative MEP monitoring was applied in all. RESULTS. Mean age was 21 years and average follow-up was 25 months. Average preoperative flexibility was 20.3% (24.1°). Average Cobb's angle, pelvic obliquity, and apical rotation were 118.2°, 16.7°, and 57° preoperatively, respectively, and 48.8°, 8°, and 43° after surgery showing significant correction of 59.4%, 46.1%, and 24.5%. Average number of osteotomy level was 4.2 and average blood loss was 3356 ± 884 mL. Mean operation time was 330 ± 46 minutes. None of the patient required postoperative ventilator support or displayed any signs of neurologic or vascular injuries during or after the operation. CONCLUSION. This technique should be recommended because (1) it provides release of anterior column without anterior approach and (2) our results supports its superiority as a technique.

Original languageEnglish
Pages (from-to)1315-1320
Number of pages6
JournalSpine
Volume34
Issue number12
DOIs
Publication statusPublished - 2009 May 20

Fingerprint

Scoliosis
Osteotomy
Nervous System Trauma
Spine
Intraoperative Monitoring
Laminectomy
Duchenne Muscular Dystrophy
Vascular System Injuries
Cerebral Palsy
Mechanical Ventilators
Prospective Studies
Lung

Keywords

  • Pedicle screw fixation
  • Posterior multilevel vertebral osteotomy
  • Safe correction
  • Severe and rigid neuromuscular scoliosis

ASJC Scopus subject areas

  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

Posterior multilevel vertebral osteotomy for correction of severe and rigid neuromuscular scoliosis : A preliminary study. / Suh, Seung-Woo; Modi, Hitesh N.; Yang, Jaehyuk; Song, Hae Ryong; Jang, Ki-Mo.

In: Spine, Vol. 34, No. 12, 20.05.2009, p. 1315-1320.

Research output: Contribution to journalArticle

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abstract = "STUDY DESIGN. Prospective study. OBJECTIVE. To determine the effectiveness and correction with posterior multilevel vertebral osteotomy in severe and rigid curves without anterior release. SUMMARY OF BACKGROUND DATA. For the correction of severe and rigid scoliotic curve, anterior-posterior combined or posterior vertebral column resection (PVCR) procedures are used. Anterior procedure might compromise pulmonary functions, and PVCR might carry risk of neurologic injuries. Therefore, authors developed a new technique, which reduces both. METHODS. Thirteen neuromuscular patients (7 cerebral palsy, 2 Duchenne muscular dystrophy, and 4 spinal muscular atrophy) who had rigid curve >100° were prospectively selected. All were operated with posterior-only approach using pedicle screw construct. To achieve desired correction, posterior multilevel vertebral osteotomies were performed at 3 to 5 levels (apex, and 1-2 levels above and below apex) through partial laminotomy sites connecting from concave to convex side, just above the pedicle; and repeated cantilever manipulation was applied over temporary short-segment fixation, above and below the apex, on convex side. On concave side, rod was assembled with screws and rod-derotation maneuver was performed. Finally, short-segment fixation on convex side was replaced with full-length construct. Intraoperative MEP monitoring was applied in all. RESULTS. Mean age was 21 years and average follow-up was 25 months. Average preoperative flexibility was 20.3{\%} (24.1°). Average Cobb's angle, pelvic obliquity, and apical rotation were 118.2°, 16.7°, and 57° preoperatively, respectively, and 48.8°, 8°, and 43° after surgery showing significant correction of 59.4{\%}, 46.1{\%}, and 24.5{\%}. Average number of osteotomy level was 4.2 and average blood loss was 3356 ± 884 mL. Mean operation time was 330 ± 46 minutes. None of the patient required postoperative ventilator support or displayed any signs of neurologic or vascular injuries during or after the operation. CONCLUSION. This technique should be recommended because (1) it provides release of anterior column without anterior approach and (2) our results supports its superiority as a technique.",
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