Analysis of the safety and complications of posterior three-column osteotomy in the treatment of congenital cervicothoracic deformity

English Keywords:Cervicothoracic  Congenital spinal deformity  Osteotomy  Complications

English Abstract:

  【Abstract】 Objectives: To analyze the outcome, safety and complications of one-stage posterior three-column osteotomy in the treatment of congenital cervicothoracic deformity. Methods: From January 2009 to March 2017, 25 patients with congenital cervicothoracic deformity who met the inclusion criteria after one-stage posterior three-column osteotomy in our center were retrospectively reviewed. There were 11 males and 14 females with a mean age of 12.1±7.1 years(ranging from 3 to 32 years). There were 6 patients with neurologic deficit before operation, including 4 patients with Frankel grade C and 2 patients with Frankel grade D. The cervicothoracic curve, local kyphosis angle, distal compensatory curve and shoulder height were measured before and after operation and during final follow-up. The correction rate and the neurological function were observed, as well as the short-term and long-term complications were recorded. Results: SRS(Scoliosis Research Society) grade 3 osteotomy was performed on 6 patients, SRS grade 4 osteotomy was performed on 3 patients, and 16 patients received SRS grade 5 osteotomy. The operation time was 306.1±101.5min(147-550min), and the blood loss was 1108.0±1000.9ml(150-4500ml). The follow-up time was 37.8±14(20-69) months. The cervicothoracic curve was significantly corrected from 59.5°±28.5° preoperatively to 28.8°±16.9° postoperatively(P＜0.001) and 31.6°±16.4° at final follow-up with no significant correction loss(P=0.574). Local kyphosis angle was significantly corrected from 39.2°±28.2° preoperatively to 21.1°±14.4° postoperatively(P＜0.001) and 24.0°±14.3° at final follow-up with no significant correction loss(P=0.478). The distal compensatory curve was corrected from 35.4°±19.5° preoperatively to 18.4°±11.3° postoperatively(P＜0.001), which increased to 26.1°±16.9° at final follow-up but with no significant difference(P=0.073). The height difference between the shoulders was reduced from 2.6±0.9cm preoperatively to 1.2±0.6cm postoperatively(P＜0.001) and furtherly improved to 0.9±0.6cm at final follow-up, but there was no significant difference compared with that after operation(P=0.093). Among the 6 patients with preoperative neurologic deficit, 5 patients recovered to Frankel E and 1 patient from Frankel C to D during follow-up. Postoperative neurological complications occurred in 6 patients: 5 patients showed numbness of the upper limbs of the convex side after operation; 1 patient underwent reoperation due to continuous decrease of lower limb muscle force. Neurological function was cured in all 6 cases during follow-up. 1 patient had cerebrospinal fluid leakage, 3 patients had pleural effusion, 1 patient had wound effusion, and 1 patient developed pulmonary infection. All patients recovered after corresponding treatment. Two patients underwent revision surgery because of the aggravation of distal scoliosis at follow-up. Conclusions: For patients with congenital cervicothoracic deformity, one-stage posterior three-column osteotomy has a high incidence of complications, but the overall effect is good.