One-stage thoracolumbar double osteotomy for severe congenital scoliosis with tethered cord syndrome

English Keywords:Severe congenital scoliosis  Tethered cord syndrome  Osteotomy  Spine-shortening  Posterior approach

English Abstract:

  【Abstract】 Objective：To evaluate the short-term efficacy of one-stage thoracolumbar double osteotomy via posterior approach for severe congenital scoliosis associated with tethered cord syndrome.Method：From June 2008 to February 2009，3 patients with severe congenital scoliosis associated with tethered cord syndrome were treated with one-stage thoracolumbar double osteotomy.All the patients were female at the age of 15，17 and 17 years old，respectively.Their pre-operative scoliosis cobb angle was 81°，123° and 141° respectively.The spinal scoliosis flexibility was 23.5%，18.7% and 0.7%.The vertical distance between C7 and the center sacral line was 6.9cm，1.6cm and 1.8cm.2 of them had kyphosis with Cobb angle 52° and 46° before operation.Among the 3 patients，2 patients were associated with unilate unsegmented bar deformity，2 with diastematopyelia，and 1 with hemivertebrae.Also，2 patients sustained progressive low back pain，1 bilateral foot pain，and all the patients had lower limb weakness，associated with gait impairment and urinary dysfunction.Result：The average surgery time was 8.1 hours with average blood loss of 3733ml（3200~4200ml）.At immediate postoperative assessment，the scoliosis was 7°，27° and 37°，showing 91.4%，78% and 73.7% scoliosis correction.The coronal imbalance was 0.2cm，0.8cm and 0.3cm showing 97.1%，50% and 83.3% correction respectively.As for the 2 patients with kyphotic deformity cobb angle 22° and 25°，the kyphotic deformity correction was 57.7% and 45.7%.All patients were followed up for 19，15 and 13 months. At the most recent follow-up，the Cobb angle was 10°，28° and 39°，showing 88.7%，77.2% and 72.3% scoliosis correction，respectively.The vertical distance between C7 and the center sacral line was 0.3cm，0.9cm and 0.4cm，showing 95.6%，43.7% and 77.7% correction.Moreover，the kyphosis cobb angle was 24° and 26°.Bony fussion was achieved in all patients，and there were no internal fixation failures or no significant correction loss.The patients′ tethered cord syndromes have been improved gradually after surgery without any symptoms in the recent follow-up.Conclusion：This surgical procedure is reliable in correcting severe deformity as well as relieving tethered cord syndromes.