Evaluation of posterior only approach using Ponte and fusion mass osteotomies in management of revision spinal deformities

Abstract

Background: Revision surgeries of spinal deformity are difficult and technically demanding with high rate of complications. Combined anterior and posterior approaches are usually required in such cases. Decreased quality of life, pain, physical limitations, and dissatisfaction with self-image are the main sequelae of revision spinal deformities. Durability of interventions for deformity treatment is the main concern for surgeons, as the revision rate is considered high. Purpose: The aim of this study is evaluation of the short-term outcomes of posterior-only approach in correction of revision spinal deformities. Study Design: Case series, prospective. Patients and Methods: Twenty patients with revision spinal deformities were included in this study between February 2015 and December 2017. The mean age was 16±5.9 (16–35) years. The patients were assessed radiologically and clinically using Visual Analogue Scale (VAS) of pain and Oswestry Disability Index (ODI). Clinical diagnosis was failed spinal deformity correction of different etiologies in patients aged more than 15 years old. All patients treated via Ponte osteotomies and fusion mass osteotomies with pedicular screw fixation through posterior approach. Results: The mean follow-up time was 27±6.2 months. The mean estimated blood loss (EBL) was 1829±388.7 ml (range, 1300–2600). The mean coronal Cobb angle showed 75.64% correction. The Visual Analogue Scale (VAS) of back pain showed 75.97% improvement. There was statistically significant improvement of the clinical scores and all radiological parameters at the end of the follow-up period. There were seven complications without serious morbidities (3 dural tears, 1 postoperative ileus, 1 delayed extubation, 1 superficial wound infection, and 1 anemia). Conclusion: Revision deformity surgeries are technically demanding procedures and should be done by well-trained spine surgeons. The posterior-only approach is an effective and safe option in management of deformity correction and achieves good union even in cases of pseudoarthrosis without serious complications. (2019ESJ183)