Correction of Severe Spinal Deformities Using Posterior Osteotomy in Young Patients: What are the Outcomes?
Background: Surgical treatment of severe spinal deformities is a big challenge for most spine surgeons. From both patient and surgeon's perspectives, balanced correction without major complications is the goal. Several strategies have been used to reach this aim. Posterior spine osteotomies (POs) eliminate longer hospital stays for traction and obviate the need for combined anterior and posterior approaches thus minimizing complications. There are potential complications associated with POs especially three column osteotomies.
Methods: This is a retrospective-cohort-study conducted on 57 patients with severe rigid spinal deformity who underwent POs from 2013-2017. Patients' demographics (e.g. age, sex), type and severity of spinal deformity, type of osteotomy including smith Peterson osteotomy (SPO), pedicle subtraction osteotomy (PSO) and vertebral column resection (VCR), duration of surgery, bleeding in perioperative period and neurological deficit were evaluated. Patients have been followed for at least two years for Cobb angles and complications such as infection and device failure.
Results: In this study, 57 patients with mean age of 21.80 ± 7.50 years were included. Etiologies were idiopathic, congenital or syndromic. For scoliotic patients, coronal Cobb angle changed from 73.21 ± 10.09 pre-operatively to 16.40 ± 6.25 after two years (p-value<0.001). For kyphotic patients, sagittal Cobb angle improved from 80.28 ± 26.59 to 45.71 ± 6.57 (pvalue< 0.001). In kyphoscoliotic cases, coronal and sagittal Cobb angles improved from 43.75 ± 22.86 and 71.25 ± 8.53 to 13.75 ± 4.78 and 36.25 ± 4.78 respectively (p-value=0.003). 10 percent of patients had transient root symptoms. There was no spinal cord lesion, and 4 patients suffered deep infections.
Conclusion: Posterior-only approaches with POs have successful outcomes in treatment of severe spinal deformities including scoliosis, kyphosis or kyphoscoliosis.