Pedicle subtraction osteotomy for rigid kyphotic scoliosis / 中华骨科杂志

ABSTRACT

Objective To introduce the indications and surgical technique of pedicle subtraction osteotomy (PSO) for patients with rigid kyphotic scoliosis. Methods Fifty-eight consecutive patients (21 males, 37 females) with rigid kyphotic scoliosis were operated with PSO at the apical vertebra. The average age was 14.1 years (ranged from 4 to 27 years). Among them, 31 were congenital deformity while 26 with idiopathic scoliosis and 1 with neurofibromatosis scoliosis. 9 had previous surgery history. The average preoperative Cobb's angle of scoliosis and kyphosis was measured as 83.7? and 78.2? on standing films and as 71.1? and 76.3? on the distraction films. On the bending films, scoliosis and kyphosis were corrected by 12.4% and 23.8% respectively. The associated neurologic deficits were observed in 14 patients, bony or fibrous septum in the canal was found in 6 patients on the preoperative CT or MRI. All patients underwent pedicle subtraction osteotomy at the convex side of the apical vertebra with segmental pedicle screw fixation or Luque instrumentation. The level of osteotomy varied from T8 through L1. Results Most patients were improved in terms of pain and radiographic examinations. The average follow-up period were 26.7 months in 49 cases (ranged from 5 to 69 months). The average residual angle of scoliosis and kyphosis was 30.0? and 21.3? respectively. The average correction rate of scoliosis and kyphosis was 64.2% and 63.5% respectively. The complete neurologic recovery was obtained in 11 and partial recovery in 2 at three months postoperatively. One case showed no improvement 12 months after surgery. No patients developed severe complications while 2 had pneumonia(3.4%), 2 had superior mesenteric artery syndrome (3.4%) and 5 had temporary dysfunction of one or both lower extremity (8.6%). The loss of correction was 1.8% at one-year follow-up. Conclusion Pedicle subtraction osteotomy is a reliable technique for severe and rigid kyphotic scoliosis both in adolescents and adults, and for severe congenital deformities and revision surgery. With pedicle subtraction osteotomy at the apical vertebra and segmental pedicle screw fixation, the rigid deformities can be corrected in one-stage, neurovascular complications can be greatly reduced, both the spinal balance and stability can be restored. The patients is able to ambulate with a brace as early as three weeks after surgery.