Scoliosis Research Society-Schwab Grade 6 Osteotomy for Severe Congenital Angular Kyphoscoliosis: An Analysis of 17 Cases With a Minimum 2-Year Follow-up.

BACKGROUND: For some patients with severe congenital angular kyphoscoliosis (SCAK), 1-level vertebral column resection is insufficient and the Scoliosis Research Society (SRS)-Schwab Grade 6 osteotomy may be necessary. However, the indications and clinical outcomes of SRS-Schwab Grade 6 osteotomy in patients with SCAK have not been investigated in depth. OBJECTIVE: To investigate the middle-term radiographic and clinical outcomes, and to evaluate the safety of this high technique-demanding procedure. METHODS: Patients with SCAK undergoing SRS-Schwab Grade 6 osteotomy from 2005 to 2016 followed up at least 2 yr were retrospectively reviewed. The potential indications of SRS-Schwab Grade 6 osteotomy were analyzed. The coronal Cobb angle, segmental kyphosis (SK), deformity angular ratio (DAR), coronal balance, and sagittal vertical axis (SVA) were measured in the preoperative, postoperative, and final follow-up. The intraoperative and postoperative complications were recorded. RESULTS: A total of 17 patients with SCAK (10 M and 7F) were included, and the mean follow-up was 30.8 ± 16.4 mo. The indications of SRS-Schwab Grade 6 osteotomy were as follows: multiple "pushed-out" hemivertebrae (13, 76.5%) and multilevel anterior block (4, 23.5%). Compared with preoperation, the coronal Cobb angle, SK and SVA at postoperation were significantly improved (P < .05 for all). The mean total DAR was 33.4 ± 9.9 at preoperation. Three patients were found to have postoperative neurological deficit. Rod breakage occurred in 3 patients at 15- to 48-mo follow-up, and revision surgeries were performed. At the last follow-up, firm bony fusion was observed in all patients. CONCLUSION: The technique-demanding SRS-Schwab Grade 6 osteotomy, if well indicated, could provide satisfying correction of the SCAK deformity.

Somatosensory and motor evoked potentials during correction surgery of scoliosis in neurologically asymptomatic Chiari malformation-associated scoliosis: A comparison with idiopathic scoliosis.

OBJECTIVES: To analyze the somatosensory evoked potentials (SEPs) and motor evoked potentials (MEPs) in neurologically asymptomatic Chiari malformation-associated scoliosis (CMS) patients with and without syringomyelia as compared with those in idiopathic scoliosis (IS) ones, and to identify whether the deformities have impacts on the neurophysiological monitoring. PATIENTS AND METHODS: This study included neurologically asymptomatic CMS patients undergoing posterior correction surgery between January 2010 and January 2016. IS patients were involved as control group and a subgroup of age- and height-matched IS patients were selected. The age, standing height and Cobb angles of main curve were measured. The SEPs latency and amplitude, MEPs amplitude, and the rate of abnormal SEPs pathologic change were compared between CMS and IS patients using independent-sample t-test and Chi-square test. RESULTS: Sixty CMS patients and 210 IS patients were included. There was no difference between CMS patients and IS or matched IS patients in SEPs latency and amplitude, MEPs amplitude or rate of abnormal SEPs (p > 0.05). Forty-eight CMS patients concurrent with syringomyelia were associated with higher Cobb angle of main curve and lower SEPs amplitude than those without syringomyelia (p < 0.05). No significant difference was found between CMS patients with and without syringomyelia in age, height, SEPs latency, MEPs amplitude or rate of abnormal SEPs (p > 0.05). CONCLUSION: Neurologically asymptomatic CMS patients showed similar absolute values of neurophysiological monitoring with IS patients. The syringomyelia in CMS indicated more severe curvature and lower SEPs amplitude even after posterior fossa decompression.

A Retrospective Study to Compare the Efficacy of Preoperative Halo-Gravity Traction and Postoperative Halo-Femoral Traction After Posterior Spinal Release in Corrective Surgery for Severe Kyphoscoliosis.

BACKGROUND This retrospective clinical study aimed to compare the efficacy of preoperative halo-gravity traction with postoperative halo-femoral traction after posterior spinal release in corrective surgery for patients with severe kyphoscoliosis. MATERIAL AND METHODS A retrospective clinical study included patients who underwent elective corrective surgery for severe kyphoscoliosis (N=60) between 2013 and 2015. Two patient groups were compared, the postoperative halo-femoral traction after posterior spinal release (R-HF) group (N=30) and the preoperative halo-gravity traction (HGT) group (N=30). Demographic and clinicopathological data included age, gender, Cobb angle, degree of spinal curvature, history of osteotomy, and etiological factors. Patients in the two study groups were matched. Postoperative surgical outcome was evaluated by the radiographic coronal Cobb angle, global kyphosis, coronal balance, and the sagittal vertical axis (SVA). Clinical outcome was assessed using the Scoliosis Research Society Outcomes Questionnaire (SRS-22). RESULTS The preoperative Cobb angle was similar between the R+HF group and the HGT group (123.5±12.7° vs. 123.1±14.1°; P=0.909). Following postoperative traction, a significantly higher correction rate was found in the R+HF group than the HGT group (31.8±7.8% vs. 19.3±12.9%; P=0.001). The postoperative correction rate in the R+HF group was significantly higher than the HGT group (44.7±7.8% vs. 39.0±12.8%; P=0.042). In both study groups, the postoperative SRS-22 scores were significantly improved with no statistical difference between the two groups, and no neurological complications occurred. CONCLUSIONS Patients with severe kyphoscoliosis who underwent postoperative halo-femoral traction after posterior spinal release achieved satisfactory radiographic correction.

Partial Hemivertebra Resection (Grade 4 Osteotomy) for Congenital Scoliosis: A Comparison with Radical Hemivertebra resection.

INTRODUCTION: To compare radiological and clinical outcomes between partial and radical hemivertebra (HV) resection in congenital scoliosis (CS) patients with single nonincarcerated HV. METHODS: CS patients with single HV undergoing partial HV resection from February 2011 to May 2016 were retrospectively reviewed and included in the P group; those undergoing radical HV resection were included in the R group. Patients in R group were age-, sex-, curve magnitude-, and apex location-matched with those in P group. Comparisons were performed in terms of radiological results, clinical outcomes, and complications preoperation, postoperation, and at the last follow-up between the P and R groups. RESULTS: Both P and R groups included 25 CS patients, and the mean age at surgery was 10.1 ± 5.2 years. Compared with the R group, the P group had a similar correction of the Cobb angle at postoperation (38.6 ± 6.7° vs. 35.2 ± 5.6°, P = 0.057) and at the last follow-up (38.4 ± 7.0° vs. 34.7 ± 6.7°, P = 0.062). The estimated blood loss was 690.9 ± 291.3 mL in the R group and 502.2 ± 223.8 mL in the P group (P = 0.023), and the operating time was 259.4 ± 70.2 minutes in the R group and 206.9 ± 61.2 minutes in the P group (P = 0.007). During follow-up, no significant correction loss and major complication were observed in the P group, whereas 1 patient in the R group had rod breakage with pseudarthrosis at 24-month follow-up. CONCLUSIONS: Partial HV resection is a safe, effective, and less invasive procedure and achieved comparable correction with radical HV resection in the treatment of CS patients with single nonincarcerated HV.