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01.03.2012 | Original Article | Ausgabe 3/2012

European Spine Journal 3/2012

Surgical treatment of severe congenital scoliosis with unilateral unsegmented bar by concave costovertebral joint release and both-ends wedge osteotomy via posterior approach

Zeitschrift:
European Spine Journal > Ausgabe 3/2012
Autoren:
Chao Li, Qingsong Fu, Yu Zhou, Haiyang Yu, Gang Zhao

Abstract

Introduction

Congenital scoliosis with unilateral unsegmented bar has remained a surgical challenge. If it is treated with a traditional release of the convex side and an apical wedge osteotomy, there is a risk of bony bridge fracture on the concave side and spine translation during correction maneuvers, which may then result in spinal cord injuries. The authors developed a technique that consists of a concave-side costovertebral joint release followed by both-ends wedge osteotomy via a posterior-only approach. In this article, we describe the technique in detail, and present the results of ten patients treated with this technique.

Methods

A total of ten patients with congenital scoliosis with unilateral unsegmented bar, who had undergone a concave-side costovertebral joint release followed by both-end wedge osteotomy via a posterior-only approach were followed up for a mean of 34 months (range 26–48 months). The radiographic parameters and clinical records were all reviewed and analyzed.

Results

Body height increased by a mean of 7.3 cm (range 6.0–9.0 cm). The preoperative coronal Cobb angle was 102° (range 83°–139°) with a mean flexibility of 14%. At the most recent follow-up visit, the mean Cobb angle was 35° (range 12°–53°) and the mean correction rate was 66%. The coronal imbalance improved from 3.4 cm (range 0.8–6.3 cm) preoperatively to 1.1 cm (range 0.6–1.8 cm) postoperatively, a 67% correction. There were no definite pseudarthroses, no implant failure, and no obvious loss of correction in the follow-up period. Complications included one patient with hemopneumothorax and another patient with incomplete paralysis of the left lower extremity caused by a pedicle screw violating the spinal canal at the T5 level. The screw was removed 4 h after the initial operation, and the patient fully recovered after 3 months.

Conclusion

We have had good results with our technique of concave-side costovertebral joint release and both-end wedge osteotomy. It has the advantage of remnant anulus fibrosus, the ligamentum flavum, and the facet joints on the concave side serving both as a hinge and to minimize translation of the spine ends. It can provide excellent three-dimensional curve correction for patients with severe rigid congenital scoliosis with unilateral unsegmented bar.

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