Spinal wedge osteotomy by a single posterior approach for correction of severe and rigid kyphosis or kyphoscoliosis.
METHODS
Seven patients with severe angular kyphotic deformity of the spine were treated by circumferential spinal wedge osteotomy using a single posterior approach.


OBJECTIVE
To evaluate the surgical outcomes for seven patients with severe angular kyphosis or kyphoscoliosis treated by spinal wedge osteotomy.


BACKGROUND
Excellent surgical outcomes have been reported for procedures such as hemivertebra excision, vertebral body resection, and spinal osteotomy for angular kyphosis or kyphoscoliosis. However, the safety and efficacy of these procedures for severe and rigid deformities have not been established.


METHODS
The surgical procedure involves circumferential exposure of the apex vertebra to the anterior aspect using a single posterior approach. Sparing only the spinal cord, the surgeon performs circumferential wedge bone resection, closure, correction, and stabilization by instrumentation while monitoring the spinal cord. Seven patients (3 kyphotics and 4 kyphoscoliotics) treated by this procedure were evaluated for a minimum of 2 years. Underlying conditions comprised five cases of congenital deformity with hemivertebrae and two cases of skeletal dysplasias. The mean age at surgery was 16.5 years, and the mean follow-up period was 6.9 years.


RESULTS
Before surgery, the mean kyphotic curve was 105.4 degrees (range, 68-150 degrees ), and the mean scoliotic curve was 85.3 degrees (range, 60-132 degrees ). After surgery, the curves averaged 48.9 degrees and 40 degrees, respectively, yielding corrections of 52.9% and 54.9%. The mean posterior trunk shift in global sagittal balance was 21 mm before surgery, becoming 3 mm after surgery. Progressive spinal cord dysfunction had developed in three patients before surgery. In all three, postoperative neurologic improvement was observed. Postoperative complications consisted of transient, unilateral leg paresis in two patients. No incidents of infection or pseudarthrosis were observed.


CONCLUSIONS
Spinal wedge osteotomy by the single posterior approach is a reliable and safe surgical technique for correcting severe rigid angular kyphosis or kyphoscoliosis.
Shimode
Masanori
M
Department of Orthopedic Surgery, Kanto Medical Center NTT EC, Tokyo, Japan. shimode@kmc.mhc.east.ntt.co.jp
Kojima
Tatsuya
T
Sowa
Kensei
K
D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006987:Hypesthesia / Q000209:etiology; D007738:Kyphosis / Q000151:congenital / Q000601:surgery*; D008297:Male; D018908:Muscle Weakness / Q000209:etiology; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D010027:Osteotomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D020127:Recovery of Function; D012600:Scoliosis / Q000151:congenital / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D013131:Spine / Q000002:abnormalities / Q000601:surgery*; D016896:Treatment Outcome