Posterior Multilevel Vertebral Osteotomy for Correction of Severe and Rigid Neuromuscular Scoliosis: A Preliminary Study

• Published in: Spine (Philadelphia, Pa. 1976) Vol. 34; no. 12; pp. 1315 - 1320
• Main Authors: SEUNG WOO SUH, MODI, Hitesh N, YANG, Jaehyuk, SONG, Hae-Ryong, J, Ki-Mo
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 20-05-2009
• Subjects: Adolescent; Adult; Biological and medical sciences; Cerebral Palsy - complications; Cerebrospinal fluid. Meninges. Spinal cord; Female; Humans; Internal Fixators; Intraoperative Complications - etiology; Intraoperative Complications - physiopathology; Intraoperative Complications - prevention & control; Male; Medical sciences; Muscular Atrophy, Spinal - complications; Muscular Dystrophy, Duchenne - complications; Nervous system (semeiology, syndromes); Neurology; Neuromuscular Diseases - complications; Neurosurgical Procedures - methods; Osteotomy - instrumentation; Osteotomy - methods; Pilot Projects; Postoperative Hemorrhage - etiology; Postoperative Hemorrhage - physiopathology; Postoperative Hemorrhage - prevention & control; Prospective Studies; Pulmonary Atelectasis - etiology; Pulmonary Atelectasis - physiopathology; Pulmonary Atelectasis - prevention & control; Radiography; Range of Motion, Articular - physiology; Reconstructive Surgical Procedures - instrumentation; Reconstructive Surgical Procedures - methods; Scoliosis - etiology; Scoliosis - pathology; Scoliosis - surgery; Spinal Fusion - instrumentation; Spinal Fusion - methods; Spine - diagnostic imaging; Spine - pathology; Spine - surgery; Treatment Outcome; Vascular diseases and vascular malformations of the nervous system; Young Adult; Nervous system diseases; Deformation; Vertebral canal; Osteotomy; Spine; pedicle screw fixation; Diseases of the osteoarticular system; Spine disease; safe correction; posterior multilevel vertebral osteotomy; severe and rigid neuromuscular scoliosis; Osteoarticular system; Fixation; Screw; Scoliosis; Central nervous system disease; Spinal cord disease; Corrections
• ISSN: 0362-2436; 1528-1159
• DOI: 10.1097/BRS.0b013e3181a028bc

Prospective study.
To determine the effectiveness and correction with posterior multilevel vertebral osteotomy in severe and rigid curves without anterior release.
For the correction of severe and rigid scoliotic curve, anterior-posterior combined or posterior vertebral column resection (PVCR) procedures are used. Anterior procedure might compromise pulmonary functions, and PVCR might carry risk of neurologic injuries. Therefore, authors developed a new technique, which reduces both.
Thirteen neuromuscular patients (7 cerebral palsy, 2 Duchenne muscular dystrophy, and 4 spinal muscular atrophy) who had rigid curve >100 degrees were prospectively selected. All were operated with posterior-only approach using pedicle screw construct. To achieve desired correction, posterior multilevel vertebral osteotomies were performed at 3 to 5 levels (apex, and 1-2 levels above and below apex) through partial laminotomy sites connecting from concave to convex side, just above the pedicle; and repeated cantilever manipulation was applied over temporary short-segment fixation, above and below the apex, on convex side. On concave side, rod was assembled with screws and rod-derotation maneuver was performed. Finally, short-segment fixation on convex side was replaced with full-length construct. Intraoperative MEP monitoring was applied in all.
Mean age was 21 years and average follow-up was 25 months. Average preoperative flexibility was 20.3% (24.1 degrees). Average Cobb's angle, pelvic obliquity, and apical rotation were 118.2 degrees, 16.7 degrees, and 57 degrees preoperatively, respectively, and 48.8 degrees, 8 degrees, and 43 degrees after surgery showing significant correction of 59.4%, 46.1%, and 24.5%. Average number of osteotomy level was 4.2 and average blood loss was 3356 +/- 884 mL. Mean operation time was 330 +/- 46 minutes. None of the patient required postoperative ventilator support or displayed any signs of neurologic or vascular injuries during or after the operation.
This technique should be recommended because (1) it provides release of anterior column without anterior approach and (2) our results supports its superiority as a technique.