ABSTRACT
The operative treatment of congenital scoliosis secondary to hemivertebra may involve in situ spinal epiphysiodesis, in situ fusion, or hemivertebra excision. The technique described in this paper, simultaneous anterior and posterior resection of the hemivertebra and correction of deformity with posterior instrumentation, has evolved from many different surgical methods used by the senior author in the past. This series of 11 patients describes the resection technique, degree of deformity correction, and complications encountered with this approach to a very difficult clinical problem. The preoperative mean age of the patients at the time of surgery was 18 months (range, 1 month-30 months), and preoperative curves averaged 47 degrees (range, 30 degrees-80 degrees). Immediate postoperative curves averaged 13 degrees (range, 1 degree-40 degrees), and at a mean of 28 months followup the curves averaged 14 degrees (range, 1 degree-47 degrees). One patient experienced transient left leg weakness. There were no long term neurologic injuries and no other surgical complications.
Subject(s)
Kyphosis/congenital , Kyphosis/surgery , Lumbar Vertebrae/abnormalities , Lumbar Vertebrae/surgery , Scoliosis/congenital , Scoliosis/surgery , Spinal Fusion/methods , Thoracic Vertebrae/abnormalities , Thoracic Vertebrae/surgery , Bone Wires , Casts, Surgical , Child, Preschool , Disease Progression , Female , Humans , Infant , Kyphosis/diagnostic imaging , Lumbar Vertebrae/diagnostic imaging , Male , Radiography , Retrospective Studies , Scoliosis/diagnostic imaging , Spinal Fusion/instrumentation , Thoracic Vertebrae/diagnostic imaging , Treatment OutcomeABSTRACT
STUDY DESIGN: This study comprised two parts: first, a feasibility study to determine the efficacy of using an image-guided Kerrison punch while performing a foraminotomy during an anterior cervical decompression and, second, an anatomic analysis using vector measurement to determine the distance from the entrance of the neuroforamen to the medial margin of the vertebral artery in the subaxial cervical spine. OBJECTIVE: To assess the feasibility of using an image-guided Kerrison punch when performing an anterior foraminotomy and to obtain data regarding the distance from the vertebral artery to the entrance of the neuroforamen. SUMMARY OF BACKGROUND DATA: The documented incidence of catastrophic iatrogenic vertebral artery injury in anterior cervical decompression is low. The use of a real-time image-guidance surgical system should reduce the risk of this complication. METHODS: Twelve cadaveric cervical spines were harvested. Standard anterior cervical discectomies with bilateral foraminotomies were performed in the subaxial cervical spine using an image-guided Kerrison. Surgically significant morphometric data were measured using a computer-assisted image-guided surgical system. RESULTS: Successful navigation into all neuroforamina in the subaxial cervical spine was attained using the image-guided Kerrison punch. The vector measurement from the neuroforamen to the vertebral artery averaged 5.8 +/- 1.2 mm at C3-C4, 6.5 +/- 1.6 mm at C4-C5, 7.9 +/- 1.4 mm at C5-C6, and 9.1 +/- 1.8 mm at C6-C7. Statistically significant differences (P < 0.05) were found between all cervical levels except C3-C4 and C4-C5. CONCLUSION: An image-guided Kerrison punch may be used successfully when performing cervical foraminotomies during an anterior cervical discectomy, thus eliminating the risk of potential vertebral artery injury. These data confirm previous findings by other authors. Knowledge of these data may aid the spine surgeon in performing a foraminotomy during anterior cervical decompression.
