Intervertebral wedge osteotomy to treat scoliosis and kyphosis

Abstract

Objective To compare the feasibility and efficacy of intervertebral wedge osteotomy and pedicle subtraction osteotomy (PSO), vertebral column resection (VCR), Smith-Petersen osteotomy (SPO) for the treatment of severe kyphosis and scoli-osis. Methods The data of 38 cases of severe kyphosis and kyphoscoliosis were retrospectively analyzed from January 2010 to February 2016, including 22 males and 16 females. According to the osteotomy mode, PSO, SPO, VCR and intervertebral disc wedge osteotomy were used to collect the average number of fixed phases, volume of bleeding, length of stay, length of hospital stay, improvement of main cobb angle, improvement of ODI score, and Frankel classification to evaluate the efficacy. Results There were no significant differences in the overall operative time between the four groups. The average number of fixation in 18 patients with SPO was (9.4±3.9) segments, the blood loss was (3 000±410) ml, the average Cobb angle was improved by 55.3%± 9.5%, the average postoperative hospitalization was (14.6±4.9) days, the improvement rate of ODI was 42.1%±7.4%, all the pa-tients were improved to Frankel E; The average number of fixation in 5 patients with PSO was (7.6±1.5) segments, the blood loss was (4 360±1 161) ml, the average Cobb angle was improved by 58.9%±15.1%, the average postoperative hospitalization was (18.2±7.0) days, the improvement rate of ODI was 41.3%±9.6%. One Frankel C patient was improved to Frankel D, others re-mained to be Frankel E as the same as pre-operation; The average number of fixation in 4 patients with VCR was (6.2±2.6) seg-ments, the blood loss was (3 750+1 848) ml, the average Cobb angle was improved by 83.9%±10.9%, the average postoperative hospitalization was (21±7.2) days, the improvement rate of ODI was 39.6%±18.1%. Three Frankel D patients were improved to Frankel E and one Frankel C patient was improved to Frankel D; The average number of fixation in 11 patients with IWO was (7.1±2.7) segments, the blood loss was (2855±1046) ml, the average Cobb angle was improved by 59.6%±22.05%, the average postoper-ative hospitalization was (13.5±2.7) days, the improvement rate of ODI was 51.3%±8.3%. One Frankel C patient was improved to Frankel D, eight Frankel D patients were improved to Frankel E, other patients remained to be Frankel E; The mean follow-up time was 25.2 months in 11 patients underwent intervertebral wedge osteotomy. All the patients had successful spinal fusion and no failure of internal fixation. Conclusion Intervertebral wedge osteotomy for the treatment of scoliosis and kyphosis could re-duce surgical injury to obtain good biomechanics and surgical result. Key words: Scoliosis; Kyphosis; Osteotomy; Spinal fusion