Spine-shortening osteotomy in treating congenital scoliosis with tethered cord

Abstract

Objective To retrospectively evaluate the safety and efficacy of spine-shortening osteotomy of 18 consecutive patients,who had congenital scoliosis with tethered cord.Methods From April 2007 to August 2011,we performed spine-shortening osteotomy on 18 patients (13 female and 5 male) to correct scoliosis deformity and decrease the tension of spinal cord simultaneously without extra untethering procedure.The average age of the patients at presentation was 14.5±3.3 years.Of the 18 cases of congenital scoliosis,there were 5 classified as failure of formation,6 as failure of segmentation,and 7 as mixed defects.The MRI images showed that all of the 18 patients had tethered cord at the level of L4 or below.Ten of the patients had vertebral column resection procedure while 8 had pedicle subtraction osteotomy procedure.Results The mean operating time was 544.5± 135.1 min,with average blood loss of 2 965.8±1 750.2 ml,and blood transfusion of 3 068.3±1 581.6 ml during operation.The average length of spine column shortening was 28.3±5.7 mm.Average fusion segments were 12.9±2.8 vertebras.All patients were successfully followed up,with an average follow up of 47.3± 16.1 months.The average coronal Cobb angles of scoliosis was 83.9°±25.7° before surgery.At the latest follow-up,the average scoliosis Cobb angle was 33.0°± 16.7°,and the correction rate was 60.7％.The average Cobb angle of kyphosis was 74.1°±19.6° before surgery.At the latest follow-up,the sagittal Cobb angle was 31.0°±10.4°,and the correction rate was 58.2％.At the final follow-up appointment,the result indicates a 57％ improvement in weakness/motor disturbances (4/7),a 100％ improvement in pain (3/3),and a 75％ improvement in sensory disturbance (3/4) following spine-shortening procedure.The urinary dysfunction and bowel incontinence in 3 patients all disappeared at the final follow-up.Three patients got complications including neurological deterioration in 2 patients; cerebrospinal fluid leakage in 1 patient.Postoperative neurological complications disappeared at 3 months follow-up.Conclusion Spine-shortening osteotomy can correct the spine deformity and release the tethered cord at the same time.It can avoid the complications of untethering operation. Key words: Scoliosis; Osteotomy; Spinal cord