Posterior based 2 or 3 Column Spinal Osteotomies and Release followed by a Controlled Halo-Pelvic Distraction in the Management of Neglected and Complicated Spinal Deformities: A Safe and New Technique

Abstract

IntroductionNeglected severe and rigid spinal deformities pose a big challenge to spine surgeons. The neglect adds other risk factors like decompensated respiratory function, fused rigid curve and neurological deficit to an already complex problem. Single stage and anterior surgery are fraught with complications in an already compromised lung condition. The visco-elastic properties of spine utilized through awake halo-pelvic distraction aided by posterior release and a posterior based 2 or 3 column osteotomy allow safe correction of deformity before a definitive procedure is planned. We present our experience of treating 3 such cases. Materials and MethodsRetrospective review of hospital records identified three patients. Two patients had neglected early onset congenital spinal deformity with intra-spinal anomaly. The third patient was an old operated case of neuromuscular scoliosis with fused spine with crankshaft phenomenon. All three patients presented with a poor pulmonary function on admission. The curves were severe( > 90°) and rigid with flexibility of only 10%. All three patients were managed by posterior release and periapical posterior based 2 or 3 column osteotomies with halo-pelvic distraction and finally posterior spinal instrumentation and fusion. ResultsMean preoperative coronal cobb's angle 102° corrected to 72.33° after posterior based osteotomies and halo-pelvic distraction alone and was 56° after final posterior instrumentation with or without intraoperative manoeuvring. The results were encouraging at three years follow-up, with improved pulmonary function. ConclusionStaged surgeries with controlled and awake, axial distraction using halo-pelvic apparatus with posterior based spinal osteotomies and release offer a safe and effective option in the treatment of severe rigid three plane deformities of the spine with severe respiratory compromise.