Posterior en bloc corpectomy followed by traction-extension and crossing rods compression for severe upper-thoracic spine angular kyphosis

English Keywords:Upper-thoracic angular kyphosis  Posterior en-bloc corpectomy  Traction-extension  Crossing rods compression correction

English Abstract:

  【Abstract】 Objective：To investigate the safety and preliminary clinical outcome of traction-extension and crossing rods compression correction after posterior en bloc corpectomy for upper-thoracic angular kyphosis.Method：From March 2005 to November 2008，10 patients with upper-thoracic angular kyphosis underwent traction-extension and crossing rods compression correction after posterior en bloc corpectomy.There were 5 males and 5 females with an average age of 17.7 years（range，4-44 years）.The pathogenesis included congenital vertebra dysplasia deformity in 7 cases，old tuberculosis in 1 case，old T3 fracture in 1 case and neurofibromatosis in 1 case.The apex vertebra was sited in T3，T4，T5 in 3 patients respectively and T6 in 1 patient.The preoperative angular kyphotic Cobb angle was 73°-155°，averaging 98.9°.The lumbar lordotic Cobb angle was 24°-81°，averaging 48.2°.The sagital trunk shift was -5.0-5.5cm.7 patients were complicated with scoliosis，whose coronal Cobb angle was 11°-110°（averaging，56.0°），and the coronal trunk shift was 0.2-6.5cm，averaging 3.24cm.For 2 cases with vertebra dysplasia and 1 case with old tuberculos presented with neurologic deficits，there were 2 Frankel C and 1 Frankel D.Result：All operations were performed successfully.The average surgical time was 10.6 hours（range，7.9-14.7h）；the average blood loss was 3750ml（range，1400-5600ml）；the average spinal cord shortening was 2.1cm（range，1.6-2.6cm）.The average number of vertebra bodies resected was 1.5，ranging from 1 to 2.The average fusion segments were 8.7 ranging from 5 to 12 segments.All patients had an average sagittal Cobb angle correction rate of 80.3% and an average lumbar lordosis correction rate of 33.5%.The average coronal Cobb angle correction rate was 79.9%，and the average sagittal trunk shift correction rate was 90.4%.The average coronal imbalance correction rate was 89.5%.All patients were followed up for 25-69 months（average，38.2 months）.The patients with neurologic deficits recovered to Frankel E.All patients got good bony fusion without neurological deficit or significant loss of correction.Conclusion：Traction-extension and crossing rods compression can provide reliable and effective correction force for severe upper-thoracic spine angular kyphosis.