The efficacy and complications of surgical treatment of congenital deformities cervicothoracic and upper thoracic spine

English Keywords:Congenital kyphoscoliosis  Cervicothoracic spine  Upper thoracic spine  Osteotomy

English Abstract:

  【Abstract】 Objectives: To evaluate the outcomes of surgical treatment of congenital deformities in the cervicothoracic and upper thoracic spine. Methods: 45 patients (28males, 17 females) undergoing surgery for congenital deformities in cervicothoracic and upper thoracic spine in our hospital from April 2005 to January 2018 were included. The mean age at surgery was 10.9±3.1（5-15） years. Standing anteroposterior and lateral radiographs were obtained at the post-operation and follow-up. CT and MRI scan of spine were taken for every patient. 12 patients had deformity with apex in cervical spine and others in thoracic spine. There were 24 formation failures, 5 segmentation failures and 16 mixed types. The average follow-up was 2.8±0.6（1-13）years. Twenty-eight patients had compensatory thoracic or thoracolumbar curve and 23 patients had congenital deformities in other parts of spine. All of them were treated with 3-column osteotomy in cervicothoracic spine or upper thoracic curve: 32 with hemivertebra resection, 10 with vertebral column resection and 3 with pedicle subtraction osteotomy. 12 patients received osteotomy in cervical spine and 33 in thoracic spine. One stage anterior and posterior approach was used in 1 patient with C6 resection and posterior-only approach was chosen for other patients. All patients were followed up for 3 months, 6 months and 1 year after surgery and whole spine X ray was taken at the time of follow-up. Radiographic measurement and chats review were taken to record the results and complications. Results: The average operation time was 269.1±65.3 minutes and the mean blood loss was 987±157ml. The cervicothoracic curve was 51.3°±13.9° before surgery, 10.3°±6.4° after surgery, and 12.4°±7.5° at final follow-up. The compensatory curve was 32.1°±23.0° before surgery, 11.1°±21.0° after surgery, and 16.3°±23.1° at final follow-up. The segmental kyphosis was 24.2°±15.2° before surgery, 9.2°±8.7° after surgery, and 10.4°±9.4° at final follow-up. The head tilting was 19.3°±5.0° before surgery, 4.6°±3.0° after surgery, and 5.7°±4.1° at final follow-up. The clavicle angle was 7.5°±3.1° before surgery, 2.7°±1.9° after surgery, and 2.1°±1.2° at final follow-up. Sagittal vertical axis was -9.1±16.1mm before surgery, -12.3±11.2mm after surgery, and -7.5±15.2mm at final follow-up. Two patients with preoperative neurological deformity totally recovered after surgery. Twenty-four complications occurred in 22 patients: 1 transient cord injury together with permanent C8 root injury, 14 transient root injuries, 1 transient Horner syndrome, 2 implant failures, 3 hemothorax, 1 wound delayed union and 1 atelectasis. Conclusions: Most congenital deformities in cervicothoracic and thoracic spine are fixed and 3-column osteotomy may be mandatory for this kind of rigid deformity to improve the correction. However, 3-column osteotomy in cervicothoracic spine(C7/T1) is technical demanding with high risk of root injury, although most of them are transient.