Asymmetrical pedicle subtraction osteotomy for the treatment of adult congenital kyphoscoliosis

English Keywords:Congenital scoliosis  Congenital kyphosis  Osteotomy  Adult

English Abstract:

  【Abstract】 Objectives: To evaluate the outcome of asymmetrical pedicle subtraction osteotomy(APSO) for the treatment of adult congenital kyphoscoliosis. Methods: From September 2009 to October 2013, 16 patients with adult congenital kyphoscoliosis underwent APSO. There were 9 males and 7 females. The average age was 23.6 years(range, 18-42 yrs). All patients presented with back pain but no neurologic deficit. The preoperative average Cobb angle of the major curve of 16 patients was 43°-97°, and the preoperative average Cobb angle of kyphosis was 15°-70°. The apex of major curve in coronal plane and the apex of kyphosis were the same in all patients. The apex of the curve located at the thoracic spine in 10 patients and lumbar spine in 6 patients. The scoliosis, kyphosis, coronal balance and sagittal balance were measured in the X-ray films preoperatively, postoperatively and at the final follow-up to evaluate the effects of APSO. All patients filled out the SRS-22 questionnaire before surgery and during follow-up to evaluate the life quality changes after APSO. Results: The average fused vertebra was 7.23(range, 5-12), the average operation time was 4.26 hours(range, 3-7 hours), the average blood loss in the operation was 1265ml(range, 700-2500ml). 1 patient with L1 osteotomy presented with leg pain after the operation. The spinal cord compression was found at the osteotomy site during the emergency operation. Decompression and laminectomy was performed at the osteotomy site. Neurologic symptom was relieved after the operation and disappeared 3 months after operation. 2 patients suffered from hemothoraxs after the operation. Closed thoracic drainage was performed and removed 1 week later. 15 patients were followed up, the average followed-up time was 13.4 months. The major curve averaged 58.67°±20.36°(43°-97°) preoperatively, 20.32°±8.76°(8°-37°) postoperatively and 21.76°±8.34°(10°-41°) at the final follow-up. The curve improved significantly after the operation(P<0.01). The correction rate was 50.76%-82.36%, averaged 65.36%. The loss of correction was 2.45% at the final follow-up. The kyphosis averaged 45.62°±16.26°(15°-70°) preoperatively, 16.35°±16.87°[(-20°)-40°] postoperatively, and 18.27°±13.92°[(-15°)-40°] at the final follow-up. The curve improved significantly after the operation(P<0.01). The correction rate was 50.97%-79.32%, averaged 64.16%. The loss of correction was 4.2% at the latest follow-up. 6 patients had preoperative coronal imbalance, and all of them restored coronal balance after the operation. 4 patients had sagittal imbalance, 3 patients restored sagittal balance and 1 patient still had sagittal imbalance after the operation. The SRS-22 score increased from 66.47±12.35(49-79) preoperatively to 84.13±6.42(76-92) during the follow-up(P<0.01). Complications included 1 neural injury and 2 hemothoraxs. All the patients got fusion at the final follow-up. There was no pseudarthrosis and instrument breakage. Conclusions: APSO can improve the coronal and sagittal spinal deformity for adult congenital kyphoscoliosis, as well as the body appearance and the body balance, which can improve the life quality of the patients.