The efficacy and safety of spinal column osteotomies in complicated adult kyphoscoliosis: a prospective study

English Keywords:Kyphoscoliosis  Osteotomies  Outcome  Complications  Adults

English Abstract:

  【Abstract】 Objectives: To evaluate the safety and clinical outcomes of spinal column osteotomies in complicated adult kyphoscoliosis． Methods: A prospective study was conducted for the complicated adult kyphoscoliosis, who underwent spinal osteotomies from September 2011 to September 2012. All the radiographic parameters were measured pre-operatively, post-operatively and at last follow-up. The spinal coronal parameters included: Cobb angle, distance between C7 plumb line and center sacral vertical line(C7PL-CSVL). The sagittal spinal parameters included: global kyphosis(GK) and sagittal vertical axis(SVA). The Scoliosis Research Society-22 questionnaire(SRS-22), the MOS item short-from health survey(SF-36), visual analogue scale(VAS), Oswestry disability index(ODI) and American Spinal Injury Association score(ASIA) were fullfilled at pre-operation and each follow-up． The paired t-test was used to analyze the differences among pre-operation, post-operation and last follow-up． Results: 17 patients(7 males and 10 females) with an average age of 34.6±10.9 years(18-55 yrs) were finally included in this study． The average follow-up period was 24.3±1.8 months． The pre-operative average Cobb angle and GK angle were 78.5°±13.1°(51°-97°) and 71.8°±19.8°(50°-112°). The post-operative average Cobb angle and GK angle were 37.7°±17.7° and 25.0°±16.4°. The correction rate of Cobb angle and GK angle were (51.9±18.7)％ and (67.2±20.3)%. At last follow-up, the average Cobb angle and GK angle were 39.5°±16.6° and 26.2°±17.6° with no significant loss of correction． The pre-operative, post-operative and last follow-up C7PL-CSVL were 58.4±21.3mm, 18.0±9.4mm and 22.1±15.4mm, respectively． Significant post-operative improvement was observed while there was no change at last follow-up. SVA decreased significantly from 56.4±51.2mm to 27.6±16.9mm. The average SVA at last follow-up was 30.4±17.1mm and no loss of correction was found． In addition, significant post-operative improvement was observed in SF-36, VAS, ODI, SRS-22 and there was no change at last follow-up. Compared with pre-operative baseline, no significant reduction in AISA scale was found in these patients. Moreover, no death or paralysis was observed in this study. The incidence of complications was 52.9%, including temporarily hypoaesthesia in 5 cases, anterior vertebral body fracture in 1 case, pedicle screw malposition in 1 case, implant complications in 2 cases. Conclusions: The spinal column osteotomy is a safe and effect surgical technique for managing complicated kyphoscoliosis in adult patients, although the procedure is exhaustingly lengthy with blood loss, and is associated with a variety of complications.