Application of staged three-column osteotomy in the surgical correction of scoliosis

English Keywords:Scoliosis  Osteotomy  Neurologic injury  Complication

English Abstract:

  【Abstract】 Objectives: To investigate the efficacy and safety of staged three-column osteotomy(S-3CO) with posterior column connection preserved in the corrective surgery for scoliosis. Methods: The clinical data of 18 patients(7 males and 11 females, 11.8±7.7 years old, followed up for 37.5±12.4 months) with scoliosis treated with S-3CO in our hospital from January 2015 to December 2022 were retrospectively analyzed(S-3CO group). The Cobb angle of the main curve, the horizontal distance between C7 and central sacral vertical line(C7-CSVL) and the sagittal vertical axis(SVA), regional Cobb angle(RCA), regional kyphosis angle(RKA) of the patients in the S-3CO group were collected and compared before operation and at the final follow-up. The complications were analyzed. 15 patients with scoliosis who received the traditional three-column osteotomy(3CO) technique during the same period were analyzed(3CO group). There were no statistical difference between the two groups in age, gender, osteotomy grade, and number of fixed segments(P>0.05). The operative time and the blood loss volume were compared between the two groups. Results: The preoperative Cobb angle of the main curve was 66.7°±23.9°, RCA was 35.3°±6.7°, and RKA was 25.2°±14.2° of the patients in the S-3CO group. The final follow-up Cobb angle of the main curve was 25.7°±13.3°, RCA was 17.6°±6.3°, and RKA was 12.6°±10.6°. The differences in the values between the final follow-up and preoperation were significantly different(P<0.05). The preoperative C7-CSVL and SVA were 27.9±14.5mm and 29.0±8.7mm, respectively, and 12.7±5.5mm and 17.4±5.6mm respectively at the final follow-up, with statistical differences(P<0.05). A total of 3 patients in S-3CO group had neuromonitoring alarms during the operation, and 1 of whom had postoperative neurological complication, which was recovered from grade 2 to grade 4 in muscle strength of the right lower limb at 2 years follow-up after conservative treatment. The operative time of S-3CO group was significantly shorter than that of the 3CO group(358.3±140.2min vs 416.3±121.2min, P<0.05), and the blood loss volume was significantly less than that of the 3CO group(850.0±359.3mL vs 977.3±236.4mL, P<0.05). Conclusions: By preserving part of the posterior column connection, S-3CO can achieve sufficient local correction and improve the overall corrective efficiency of scoliosis. Preserving the connection and protection of the posterior structure during osteotomy reduces the risk of neurologic injury.