Safety and efficacy of osteotomy for congenital congenital scoliosis combined with split spinal cord malformation

Abstract

Objective To retrospectively evaluate the safety and efficacy of osteotomy for progressive congenital scoliosis combined with split spinal cord malformation (SSCM).Methods Data of 31 patients,who had undergone osteotomy for progressive congenital scoliosis combined with SSCM from May 2008 to May 2011 in our hospital,were retrospectively analyzed.Twenty-nine patients were followed up successfully,including 11 males and 18 females,aged from 6 to 26 years (average,13 years).Seven patients had tethered cord syndrome (TCS) with progressive neurologic deterioration.Hemivertebrae resection was performed in 7 patients,pedicle subtraction osteotomy (PSO) in 16,and vertebral column resection (VCR) in 6; posterior fusion surgery was performed in all patients after the correction was obtained.Results Twenty-nine patients were followed up for 8 to 24 months (average,18 months).The coronal Cobb angle ranged from 15° to 40°(average,24.4°±18.6°) immediately after operation,with an average correction rate of 63.3％.The coronal apical vertebral translation ranged from 0 to 50 mm (average,21.1±19.2 mm) immediately after operation,with an average correction rate of 59.5％.The coronal thoracic trunk shift ranged from 0 to 28 mm (average,5.5±10.5 mm) immediately after operation,with an average correction rate of 55.0％.There were significant differences between pre-and post-operative coronal Cobb angle,coronal apical vertebral translation and coronal thoracic trunk shift.There was no permanent neurological deterioration in all patients.Pedicle screw break occurred in 4 patients,without permanent neurological compromise.Among 7 patients with TCS,muscle strength was improved in 3 patients,and urination control was improved in 1 patient.Conclusion The osteotomy for congenital scoliosis combined with SSCM is a satisfactory method,which can effectively improve the spinal deformity without significant complications.For patients with TCS,this method also can improve the restoration of neurosurgical function.However,additional large multicenter studies are necessary to further assess the safety and efficacy. Key words: Scoliosis; Spinal cord; Abnormalities; Neural tube defects; Osteotomy