226. Sequential correction of the severe and rigid thoracic kyphoscoliosis: a new technical note and preliminary results

Abstract

BACKGROUND CONTEXT Although posterior vertebral column resection has traditionally been used to correct severe and rigid kyphoscoliosis, sequential correction combined with transpedicular wedge resection osteotomy may achieve the same correction with a shorter operative time and lower rate of complications. PURPOSE To determine the efficacy of a new sequential correction technique combined with transpedicular wedge resection osteotomy for severe and rigid thoracic kyphoscoliosis STUDY DESIGN/SETTING Retrospective analysis of clinical records. PATIENT SAMPLE Between May 2011 and December 2017, 16 adults were included in the present study. OUTCOME MEASURES Radiological measurements, including coronal plane major curve, kyphotic curve, coronal offset, and sagittal offset, were measured and compared. The following patient-reported health-related quality of life outcomes, including Oswestry Disability Index score, visual analog scale (VAS) score for back pain, and SRS-22 questionnaire, were used to evaluate the clinical outcomes. METHODS All the patients included underwent a transpedicular wedge resection osteotomy of the apical vertebrae for severe and rigid thoracic kyphoscoliosis and sequential correction. Stepwise closing of the osteotomy sites was performed with two short rods, then cantilever reduction maneuver was performed with concave side short rod preserved. RESULTS All these patients were followed over 24 months, the mean coronal plane major curve improved from 115.2±29.0° to 43.1±15.5° immediately after surgery and to 45.5±15.1° at 24 months postoperatively. The mean kyphotic curve improved from 99.6±33.1° to 32.1±19.7° immediately after surgery and to 33.9±19.0° at 24 months postoperatively. The mean coronal offset and sagittal offset were also improved. Improved self-reported quality of life scores were achieved postoperatively and at 24 months postoperatively, including all domains of the SRS-22 questionnaire. Bony fusion was achieved at 6 or 12 months in all patients. Unilateral leg paresis occurred in one case and recovered after three months, with a neurological complication rate of 6.2%. CONCLUSIONS The sequential correction technique combined with transpedicular wedge resection osteotomy is an excellent treatment for severe and rigid thoracic kyphoscoliosis in adult patients provided excellent clinical outcomes. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.