Efficacy of single-level osteotomy in the treatment of kyphoscoliosis of vertebral malformation type

Abstract:

Objective：To evaluate the efficacy of single-level osteotomy in the treatment of malformation typed congenital kyphoscol－iosis（CKS）. Methods：Nineteen consecutive cases of malformation typed CKS patients from July 2006 to May 2012 with single-level osteotomy and posterrior pedicle screw fixation were investigated retrospectively，in which 9 cases were conducted by pedicle subtrac－tion osteotomy（PSO） and 10 cases were conducted by vertebra column resection（VCR）. The average age was 19.2 years and the av－erage follow-up time was 4.2 years. The surgical and radiographic information were comparatively analyzed. Visual Analogue Scale（VAS），the American Spinal Injury Association （ASIA） classification and the complications along the follow-up time were reviewed. Results：Mean operative time was （302.1±43.2） min with average blood loss of （589.5±151.5） ml and average fusion segment of 6.0±1.5. The correction rates of scoliosis Cobb’s angle，segmental kyphosis Cobb’s angle and distance of vertical line between the 7th vertebra and central sacra（C7-CSL） were （79.7±9.2）%，（81.1±21.9）%，（82.7±12.5）%，respectively. The parameters above were not significantly different between PSO group and VCR group except the preoperative segmental kyphosis Cobb’s angle（P >0.05），of which，PSO group was 22.7°±22.0°，VCR group was 62.2°±21.0°（t=4.009，P=0.001）. At last follow-up，no significant progress was observed in scoliosis Cobb’s angle，segmental kyphosis Cobb’s angle and C7-CSL. VAS improvement rate was （85.9±15.9）%. Three cases improved from D to E in ASIA classification. One case of cerebrospinal fluid leakage，two cases of unilateral numbness and one case of back pain were observed without any sign of wound infection or implant failure. Conclusion：Single-level osteotomy with posterior pedicle screw fixation is safe and feasible with ex－cellent correction. For sagittal correction，VCR procedure shows significant advantage.