Osteotomias posteriores de três colunas para tratamento de cifose dorsal rígida – Série de casos

Abstract

ObjectiveTo evaluate the results and complications of a series of patients who underwent three‐column osteotomy using the posterior approach for correction of complex cases of rigid dorsal kyphotic deformity. MethodsReview of clinical records and images of 15 consecutive cases of pedicle subtraction osteotomies, bone‐disc‐bone osteotomies, or vertebral column resection, recording the etiology, type and level of osteotomy, extension of fixation, complications, and pre‐ and post‐surgical measurements of the sagittal curves and pelvic parameters. ResultsSix pedicle subtraction osteotomies were performed, one of which in two adjacent vertebrae, as well as two bone‐disc‐bone osteotomies and seven vertebral column resection, two of which were performed in two adjacent vertebrae. The mean correction was 39.3° for the angular kyphosis and 33.9° for dorsal kyphosis. The corrections were similar regardless of the kind of osteotomy, the operated spinal segment, or the approach in one or two levels, but this may be a sample effect.Eight complications were observed in six patients (40% of cases):two medical complications, five early and one late surgical complication (over 90 days after surgery). There were three reoperations within less than one year from the initial surgery and one case of persistent paraparesis. Clinical complications were resolved without sequelae. There was no significant loss of correction during the segment, except in two cases of major mechanical failure due to a junctional segment fracture. ConclusionDespite being complex and aggressive procedures, prone to various complications, osteotomies with resection of the three columns are highly effective in the correction of rigid kyphotic deformities and safe enough to justify its use in selected cases.