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Wu H, Ding J, Yang J, Sui W. Postoperative dysesthesia after PVCR without anterior support applied in Yang's type A severe spinal kyphoscoliosis. Front Surg 2023; 10:1222520. [PMID: 37538390 PMCID: PMC10394467 DOI: 10.3389/fsurg.2023.1222520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 07/03/2023] [Indexed: 08/05/2023] Open
Abstract
Backgrounds The incidence and characteristics of postoperative dysesthesia (POD) have not been reported for posterior vertebral column resection (PVCR) in the treatment of severe spinal kyphoscoliosis. Objective The objective of the study is to investigate the incidence and characteristics of POD in PVCR without anterior support applied in Yang's type A severe spinal kyphoscoliosis. Material and methods From August 2010 to December 2019, 167 patients diagnosed with Yang's type A severe spinal kyphoscoliosis who underwent PVCR without anterior support applied were retrospectively reviewed. All the patients were monitored using five modes of intraoperative multimodal neurophysiological monitoring. Neuromonitoring data, radiographic parameters, and neurological complications were reviewed and analyzed. The incidence and characteristics of POD were further summarized. POD was defined as dysesthetic pain or burning dysesthesia which could be caused by spinal cord kinking or dorsal root ganglion (DRG) injury but with no motor deficits. Results PVCR without anterior support was successfully conducted in all 167 patients. Intraoperative monitoring events occurred in five patients. One out of these five patients showed postoperative spinal cord injury (Frankel level C) but completely recovered within 9 months postoperation (Frankel level E). The number of levels and osteotomy space for vertebra resection were 1.28 and 3.6 cm, respectively. POD was confirmed in three patients (3/167, 1.8%), characterized as kyphosis with the apex vertebrae in T12 with the kyphotic Cobb angles of 100°, 115°, and 122°, respectively. The osteotomy space of vertebra resection in these three patients were 3.9, 3.8, and 4.2 cm, respectively. After the treatment by drug administration, they reported pain relief for 12-36 days. The pain gradually moved to the distal end of a proper DRG innervated region near the end. Conclusions In this study, the incidence rate of POD in Yang's type A severe spinal kyphoscoliosis patients who underwent PVCR without anterior support applied was 1.8% (3/167). Evoked potential monitoring could not detect the occurrence of POD. POD in Yang's type A severe spinal kyphoscoliosis after PVCR could be ascribed to spinal cord kinking and DRG injury.
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Affiliation(s)
- Hangqin Wu
- Department of Orthopaedic Surgery, Wuyi County First People's Hospital, Zhejiang, China
| | - Jie Ding
- Department of Orthopaedic Surgery, Changxing People's Hospital of Chongming District, Shanghai, China
| | - Junlin Yang
- Spine Center, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenyuan Sui
- Spine Center, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Ould-Slimane M, Hossein Nabian M, Simon AL, Happiette A, Julien-Marsollier F, Ilharreborde B. Posterior vertebral column resection for pediatric rigid spinal deformity. Orthop Traumatol Surg Res 2022; 108:102797. [PMID: 33333284 DOI: 10.1016/j.otsr.2020.102797] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 07/09/2020] [Accepted: 07/21/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Surgery for pediatric spinal deformity may involve vertebral osteotomies in complex cases. Vertebral column resection (VCR) is the most technically demanding procedure, with the severest morbidity. It can use a double anterior and posterior approach (APVCR), though a single posterior approach (PVCR) is gaining in popularity. HYPOTHESIS PVCR provides effective correction with acceptable morbidity in children. METHOD A single-center retrospective series included spinal deformities treated by PVCR. Surgical data and global pelvic-spinal balance parameters were analyzed. RESULTS Sixteen PVCRs were performed in 13 patients, with a mean age of 14.1±2.8 years. Mean operative time was 411±54minutes. Mean preoperative rigid principal Cobb angle was 74.3°. Mean correction was 64.3% postoperatively, without significant correction loss at last follow-up. Mean blood loss was 941±221ml. The cell-saver enabled 92.3% autologous transfusions, with 53.4% homologous transfusions. Transient monoplegia and permanent psoas deficit were observed during the postoperative period. Radiologic follow-up found 4 non-unions requiring revision. CONCLUSION PVCR provided major correction of rigid spinal deformity in children. Complications mainly comprised mechanical or neurological incidents. LEVEL OF EVIDENCE IV, non-comparative cohort study.
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Affiliation(s)
- Mourad Ould-Slimane
- Department of Orthopedic Surgery, Spine Unit, Rouen University Hospital, institut Rouennais du Rachis, CHU de Rouen, 1, rue de Germont, 76000 Rouen, France.
| | - Mohammad Hossein Nabian
- Department of Orthopedic and Trauma Surgery, Shariati Hospital, Tehran University, Tehran, Iran
| | - Anne-Laure Simon
- Service de chirurgie orthopédique infantile, CHU de Robert-Debré, Paris, France
| | - Adèle Happiette
- Service de chirurgie orthopédique infantile, CHU de Robert-Debré, Paris, France
| | | | - Brice Ilharreborde
- Service de chirurgie orthopédique infantile, CHU de Robert-Debré, Paris, France
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Ouyang B, Luo C, Ma X, Zou X, Lu T, Chen Q, Pu X. [Comparison of radiological changes after Halo-pelvic traction with posterior spinal osteotomy versus simple posterior spinal osteotomy for severe rigid spinal deformity]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:900-906. [PMID: 32666736 DOI: 10.7507/1002-1892.201911153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To compare the changes of scoliosis and kyphosis angles after Halo-pelvic traction with posterior spinal osteotomy versus simple posterior spinal osteotomy for severe rigid spinal deformity. Methods A clinical data of 28 patients with severe rigid spinal deformity between January 2015 and November 2017 was retrospectively analyzed. Sixteen patients were treated by Halo-pelvic traction with posterior spinal osteotomy (group A) and 12 patients were treated with posterior spinal osteotomy only (group B). There was no significant difference between the two groups ( P>0.05) in gender, age, body mass index, and preoperative pulmonary function, coronal and sagittal Cobb angles, and flexibility. The operation time, intraoperative blood loss, and complications were recorded. The coronal and sagittal Cobb angles were measured on X-ray films before operation (before traction in group A), at 10 days after operation, at last follow-up in the two groups and after traction in group A. The improvement rate of deformity after traction in group A, the correction rate of deformity after operation, and the loss rate of correction at last follow-up were calculated. Results All patients were followed up 24-30 months (mean, 26.5 months). The operation time and intraoperative blood loss were significantly less in group A than in group B ( t=7.629, P=0.000; t=8.773, P=0.000). In group A, 1 patient occurred transient numbness of both legs during continuous traction and 2 patients needed ventilator support for more than 12 hours. In group B, 7 patients needed ventilator support for more than 12 hours, including 1 patient with deep incision infection. The incidence of complications was 18.75% (3/16) in group A and 58.33% (7/12) in group B, and the difference between the two groups was significant ( χ 2=4.680, P=0.031). The coronal and sagittal improvement rates of deformity after traction in group A were 40.47%±3.60% and 40.70%±4.20%, respectively. There was no significant difference between the two groups ( P>0.05) in the coronal and sagittal Cobb angles at 10 days after operation and at last follow-up, in the correction rate of deformity after operation, and in the loss rate of correction at last follow-up. Conclusion For the severe rigid spinal deformity, Halo-pelvic traction with posterior spinal osteotomy and simple posterior spinal osteotomy can obtain the same orthopedic effect and postoperative deformity correction. However, the Halo-pelvic traction can shorten operation time, reduce blood loss and incidence of perioperative complications.
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Affiliation(s)
- Beiping Ouyang
- Department of Spine Surgery, Guizhou Provincial Orthopedics Hospital, Guiyang Guizhou, 550004, P.R.China
| | - Chunshan Luo
- Department of Spine Surgery, Guizhou Provincial Orthopedics Hospital, Guiyang Guizhou, 550004, P.R.China
| | - Xiangyang Ma
- Department of Orthopedics, General Hospital of Southern Theatre Command of Chinese PLA, Guangzhou Guangdong, 510010, P.R.China
| | - Xiaobao Zou
- Department of Orthopedics, General Hospital of Southern Theatre Command of Chinese PLA, Guangzhou Guangdong, 510010, P.R.China
| | - Tingsheng Lu
- Department of Spine Surgery, Guizhou Provincial Orthopedics Hospital, Guiyang Guizhou, 550004, P.R.China
| | - Qiling Chen
- Department of Spine Surgery, Guizhou Provincial Orthopedics Hospital, Guiyang Guizhou, 550004, P.R.China
| | - Xingwei Pu
- Department of Spine Surgery, Guizhou Provincial Orthopedics Hospital, Guiyang Guizhou, 550004, P.R.China
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Lau D, Deviren V, Ames CP. The impact of surgeon experience on perioperative complications and operative measures following thoracolumbar 3-column osteotomy for adult spinal deformity: overcoming the learning curve. J Neurosurg Spine 2020; 32:207-220. [PMID: 31653817 DOI: 10.3171/2019.7.spine19656] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 07/29/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Posterior-based thoracolumbar 3-column osteotomy (3CO) is a formidable surgical procedure. Surgeon experience and case volume are known factors that influence surgical complication rates, but these factors have not been studied well in cases of adult spinal deformity (ASD). This study examines how surgeon experience affects perioperative complications and operative measures following thoracolumbar 3CO in ASD. METHODS A retrospective study was performed of a consecutive cohort of thoracolumbar ASD patients who underwent 3CO performed by the senior authors from 2006 to 2018. Multivariate analysis was used to assess whether experience (years of experience and/or number of procedures) is associated with perioperative complications, operative duration, and blood loss. RESULTS A total of 362 patients underwent 66 vertebral column resections (VCRs) and 296 pedicle subtraction osteotomies (PSOs). The overall complication rate was 29.4%, and the surgical complication rate was 8.0%. The rate of postoperative neurological deficits was 6.2%. There was a trend toward lower overall complication rates with greater operative years of experience (from 44.4% to 28.0%) (p = 0.115). Years of operative experience was associated with a significantly lower rate of neurological deficits (p = 0.027); the incidence dropped from 22.2% to 4.0%. The mean operative time was 310.7 minutes overall. Both increased years of experience and higher case numbers were significantly associated with shorter operative times (p < 0.001 and p = 0.001, respectively). Only operative years of experience was independently associated with operative times (p < 0.001): 358.3 minutes from 2006 to 2008 to 275.5 minutes in 2018 (82.8 minutes shorter). Over time, there was less deviation and more consistency in operative times, despite the implementation of various interventions to promote fusion and prevent construct failure: utilization of multiple-rod constructs (standard, satellite, and nested rods), bone morphogenetic protein, vertebroplasty, and ligament augmentation. Of note, the use of tranexamic acid did not significantly lower blood loss. CONCLUSIONS Surgeon years of experience, rather than number of 3COs performed, was a significant factor in mitigating neurological complications and improving quality measures following thoracolumbar 3CO for ASD. The 3- to 5-year experience mark was when the senior surgeon overcame a learning curve and was able to minimize neurological complication rates. There was a continuous decrease in operative time as the surgeon's experience increased; this was in concurrence with the implementation of additional preventative surgical interventions. Ongoing practice changes should be implemented and can be done safely, but it is imperative to self-assess the risks and benefits of those practice changes.
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Affiliation(s)
| | - Vedat Deviren
- 2Orthopedic Surgery, University of California, San Francisco, California
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Atıcı Y, Polat B, Erdoğan S, Çarkçı E, Polat AE, Demiröz S, Benli İT. Radiologic Outcomes and Complication Analysis of the Posterior Vertebral Column Resection in the Treatment of Previously Operated Severe Kyphoscoliosis: A Retrospective Case Series. World Neurosurg 2020; 138:e690-e697. [PMID: 32194269 DOI: 10.1016/j.wneu.2020.03.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 03/06/2020] [Accepted: 03/06/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the radiologic outcomes and complication analysis of posterior vertebral column resection (PVCR) performed on previously operated patients with severe kyphoscoliosis (SK). METHODS Twelve patients (6 men and 6 women) with SK underwent PVCR. The mean age of the patients preoperatively was 16 years (range, 10-26 years). The mean follow-up period was 5.3 years (range, 2-7 years). Previous surgeries included posterior growth arrest in 3 patients, hemivertebrectomy in 4 patients, and posterior fusion in 5 patients. The sagittal plane parameters and coronal parameters were measured in the preoperative, in the early postoperative, and during the last follow-up stages. Complications were also noted. RESULTS The mean thoracic scoliosis Cobb angle was 76.8° (range, 35°-142°) preoperatively, 37.8° (range, 5°-80°) early postoperatively, and 41.5° (range, 11°-80°) during the last follow-up (P < 0.0001). The mean thoracic kyphosis angle was 84.7° (range, 23°-132°) preoperatively, 50.3° (range, 25°-78°) early postoperatively, and 48.5° (range, 25°-80°) during the last follow-up (P = 0.0032). Complications occurred in 5 patients (41.7%); a hemothorax in 1 patient, rod fracture in 3 patients, and permanent neurologic deficit in 1 patient. Temporary loss of neuromonitoring motor evoked potentials developed in 2 patients during deformity correction. CONCLUSIONS PVCR provides effective correction in patients with SK. However, expected surgical correction of a deformity may not always be achieved because of intraoperative neuromonitoring changes. Furthermore, PVCR can lead to a large number of major complications in patients with SK who have undergone previous spinal surgery.
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Affiliation(s)
- Yunus Atıcı
- Department of Orthopedic Surgery, Medical Park Gebze Hospital, Gebze, Kocaeli, Turkey
| | - Barış Polat
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Kyrenia, Kyrenia, Turkish Republic of North Cyprus.
| | - Sinan Erdoğan
- Department of Orthopedic Surgery, Baltalimanı Bone and Joint Diseases Training and Research Hospital, Istanbul, Turkey
| | - Engin Çarkçı
- Department of Orthopedic Surgery, Istanbul Training and Resarch Hospital, Istanbul, Turkey
| | - Ayşe Esin Polat
- Department of Orthopaedic Surgery, Dr. Akçiçek State Hospital, Kyrenia, Turkish Republic of North Cyprus
| | - Serdar Demiröz
- Department of Orthopedic Surgery, Medical Park Gebze Hospital, Gebze, Kocaeli, Turkey
| | - İsmet Teoman Benli
- Department of Orthopedic Surgery, Faculty of Medicine, Başkent University, Istanbul, Turkey
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Sehmisch S, Lehmann W, Dreimann M, Oberthür S, Viezens L, Weiser L. [Posterior vertebral column resection for correction of kyphotic deformity due to osteoporotic fractures of the thoracic spine]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2019; 31:311-320. [PMID: 31278505 DOI: 10.1007/s00064-019-0616-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 01/25/2019] [Accepted: 04/02/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The posterior vertebral column resection (PVCR) comprises a one-step resection of the vertebral body by a costotransversectomy together with a 360° spondylodesis. After removing the vertebral body, straightening of the existing kyphotic malposition is possible. INDICATIONS Pronounced thoracic kyphosis after osteoporotic sintering fractures in one or more vertebral bodies. CONTRAINDICATIONS General contraindications for surgical procedures, ASA >3 (American Society of Anesthesiologists). SURGICAL TECHNIQUE First, dorsal stabilization of the vertebral column on at least two levels cranial and caudal of the VCR. Next, in a one-step procedure the laminectomy with costotransversectomy and the resection of the vertebral body is done. The ventral defect gap is filled by a mesh cage to provide ventral support. By compression the malposition is reduced and the mesh cage is fixed into position. Finally the vertebrae joints are opened up using a chisel and bone or bone substitute is placed to complete the 360° spondylodesis. POSTOPERATIVE MANAGEMENT Functional treatment without peak load exercises as well as appropriate osteoporosis treatment. RESULTS In a retrospective study 10 patients treated with this surgical technique were investigated. The results show a very good correction of the kyphotic maldeformity while the complications remain moderate.
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Affiliation(s)
- S Sehmisch
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland.
| | - W Lehmann
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland
| | - M Dreimann
- Klinik und Poliklinik für für Unfall‑, Hand- und Wiederherstellungschirurgie, Spine Center, Universitätsklinikum Hamburg Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - S Oberthür
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland
| | - L Viezens
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland
| | - L Weiser
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland
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