Clinical study of one-stage three-column osteotomy in treatment of congenital scoliosis combined with spinal cord deformity

English Keywords:Congenital scoliosis  Three-column osteotomy  Spinal cord deformity  Split cord malformation  Syringomyelia  Tethered spinal cord syndrome

English Abstract:

  【Abstract】 Objectives: To evaluate the effectiveness and safety of one-stage three-column osteotomy in treatment of patients with congenital scoliosis combined with spinal cord deformity. Methods: 62 patients with congenital scoliosis combined with spinal cord deformity from January 2015 to May 2017 were studied. Including 32 male and 30 female patients, aged 15.3±8.3 years(7-35 years) and 46 patients with neurological symptoms. All patients underwent one-stage three-column osteotomy and were followed up for 12 months. The operative time, intraoperatve blood loss and postoperative complication was recorded. The neurological function was evaluated by spina bifida neurological scale(SBNS), the pain degree was evaluated by visual analogue scale(VAS), the coronal Cobb angle, sagittal posterior convex Cobb angle, trunk migration were measured by positive and lateral position Ｘ-ray of total spine, the correction rate and loss rate were calculated before operation, at 3 momths after operation and at final follow-up. Results: The operative average time, intraoperatve average blood loss was 565.3±140.8min, 3570.6±1855.4ml, respectively. At 3 momths after operation, the average coronal Cobb angle was 41.7°±17.7° and the average correction rate was (62.5±13.8)%, the average posterior convex Cobb angle was 38.5°±11.2° and the average correction rate was (66.4±22.6)%. At final follow-up, the average coronal Cobb angle was 43.7°±16.6° and the average loss rate was (1.9±1.1)%, the average posterior convex Cobb angle was 39.7°±11.3° and the average loss rate was(2.3±1.4)%. At 3 momths after operation and at final follow-up, the Cobb angle, trunk migration, SBNS score and VAS score was significantly improved(P<0.05). 28 patients were improved from preoperative SBNS grade Ⅱ to grade Ⅰ, 9 patients were improved from preoperative SBNS grade Ⅲ to grade Ⅱ. There were 14 patients with lumbosacral pain, 9 patients with lower limb muscle strength decreased, 8 patients with urination and defecation function disturbance, 4 patients with lower limbs tiny which was improved. There were 8 cases of postoperative complications including 3 patients with cerebrospinal fluid leak, 2 patients with wound infection and 3 patients with urinary system infection. Conclusions: One-stage three-column osteotomy was safe and effective in the treatment of patients with congenital scoliosis combined with spinal cord deformity and it could promote the recovery of neurological function.