title: Expanded eggshell procedure combined with closing-opening technique (a modified vertebral column resection) for the treatment of thoracic and thoracolumbar angular kyphosis.
abstract: OBJECTIVE
  The purpose of this study was to determine the efficacy of a modified vertebral column resection for the treatment of thoracolumbar angular kyphosis.
  
  
  METHODS
  A total of 13 patients (8 male, 5 female) with thoracolumbar kyphosis (kyphotic angle > 60°) were included in this study (Group A). There were 3 patients with failure of spinal formation (Type 1 deformity), 6 patients with old thoracic or lumbar compression fracture, and 4 patients with old spinal tuberculosis (including 1 case of T3-5 vertebral malunion). The average preoperative kyphotic angle was 67.3° (range 62°-75°). Each patient underwent an expanded eggshell procedure combined with the closing-opening technique for the treatment of thoracolumbar angular kyphosis. Sixteen patients who were previously treated with a closing-opening wedge osteotomy in the same spine classification group (kyphotic angle > 60°) were used as a control group (Group B).
  
  
  RESULTS
  In Group A, the average (± SD) operative time was 400 ± 60 minutes, and the average blood loss was 960 ± 120 ml. There were no surgery-related complications observed during or after the operations. The average local kyphotic angle was 20.3° (range 18°-24.5°), and the average correction rate was 68.7%. In Group B, the average operative time was 470 ± 90 minutes, and the average blood loss was 2600 ± 1600 ml (range 1200-8200 ml). There were segmental vessels and spinal canal venous plexus injury in 1 case, spinal cord injury in 1 case, dural tearing in 2 cases, pleural rupture in 2 cases, and hemothorax and pneumothorax in 1 case. Each patient had more than 2 years of follow-up. At the latest follow-up examination, the average regional kyphotic angle was 19.9° ± 9.1° (range 19°-34°), and there was no significant loss of correction (p > 0.05). There was greater blood loss and a higher complication rate in Group B than in Group A (p < 0.05).
  
  
  CONCLUSIONS
  An expanded eggshell procedure combined with the closing-opening technique for the treatment of thoracolumbar angular kyphosis resulted in significant reduction of the kyphotic angle, few complications, and good follow-up results. However, a larger series of patients and long-term follow-up results is still required to verify the effectiveness and safety of this method.
authors.affiliation: Department of Orthopedic Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, People's Republic of China.
authors.forename: Xinyu
authors.initials: X
authors.lastname: Liu
authors.affiliation: Department of Orthopedic Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, People's Republic of China.
authors.forename: Suomao
authors.initials: S
authors.lastname: Yuan
authors.affiliation: Department of Orthopedic Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, People's Republic of China.
authors.forename: Yonghao
authors.initials: Y
authors.lastname: Tian
authors.affiliation: Department of Orthopedic Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, People's Republic of China.
authors.forename: Lianlei
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Orthopedic Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, People's Republic of China.
authors.forename: Yanping
authors.initials: Y
authors.lastname: Zheng
authors.affiliation: Department of Orthopedic Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, People's Republic of China.
authors.forename: Jianmin
authors.initials: J
authors.lastname: Li
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D007738:Kyphosis / Q000000981:diagnostic imaging / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D061646:Operative Time; D010147:Pain Measurement; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: ASIA = American Spinal Injury Association; COWO = closing-opening wedge osteotomy; LL = lumbar lordosis; PI = pelvic incidence; PSO = pedicle subtraction osteotomy; PT = pelvic tilt; PVCR = posterior vertebral column resection; RKA = regional kyphotic angle; SPO = Smith-Petersen osteotomy; SVA = sagittal vertical axis; TK = thoracic kyphosis; VAS = visual analog scale; VCR = vertebral column resection; closing-opening procedure; correction; eggshell; kyphosis; technique; thoracic spine