One stage circumferential osteotomy by combined approach in the treatment of congenital cervical scoliosis

English Keywords:Congenital cervical scoliosis  Hemivertebra  Torticollis  Circumferential osteotomy

English Abstract:

  【Abstract】 Objectives: To apply one stage circumferential osteotomy to treat the congenital cervical scoliosis(also called as osteogenic torticollis), and to evaluate the feasibility, safety and early clinical outcomes. Methods: Thirteen cases of congenital cervical scoliosis with hemivertebra deformity who received surgical correction were retrospectively reviewed. The clinical outcomes were evaluated. The severe complications such as injury of nerve root, spinal cord, vertebral artery and dural sac were collected and recorded. The Cobb angles of structural curve and compensatory curve were recorded and compared on coronal plane reconstruction images in CT scan. Results: 13 patients with an average age of 9.2±3.4 years old(5-15) were treated. There were 8 males and 5 females. Two cases had anterior-posterior osteotomy with Halo-vest immobilization for three months. 11 cases had anterior-posterior-anterior osteotomy with soft collar for 6 weeks. The average operation time was 324±92mins with an average blood loss of 585±319ml. Five cases had convex side nerve root symptoms postoperatively. Four cases fully recovered at 6 months after the operation. One case remained triceps power reduction(grade 3) at 24 months after the operation. No other complication was occured. The average follow-up period was 30.0±12.4 months(24-60 months). The Cobb angle of structural curve was 28.3°±11.0°(9°-45°) preoperatively and 6.9°±7.8°(0°-25°) postoperatively. The correction ratio was (78±24)%. The Cobb angle of compensatory curve was 21.8°±5.8°(0°-25°) preoperatively and 5.5°±4.3°(3°-23°) postoperatively. The correction ratio was (37±33)%. The patient′s appearance improved significantly after the surgery. Conclusions: The one stage circumferential osteotomy for the treatment of congenital cervical scoliosis is feasible and safe. The clinical and radiological outcomes are satisfactory.