THREE COLUMN VERTEBRECTOMY OUTSIDE THE APICAL ZONE AS A METHOD FOR CORRECTION OF CERVICOTHORACIC JUNCTION DEFORMITIES: ANALYSIS OF CLINICAL SERIES AND LITERATURE DATA

Abstract

Objective. To perform a retrospective analysis of early treatment results in patients with malformation and malsegmentation of vertebrae in the cervical and upper thoracic spine. Level of evidence – IV. Material and Methods . The study included retrospective monocentre series of 8 patients aged 2–15 years. Inclusion criteria were: age at the time of surgery less than 15 years, deformity in the frontal plane, performed three-column osteotomyies, and presence of full X-ray history. Results . Patients with multiple developmental abnormalities including vertebral malsegmentation and malformation as leading components prevailed in a series. Violations of the sagittal balance were not noted. Preoperative magnitude of the scoliotic curve ranged from 30° to 66 ° (mean value – 46.1°) according to Cobb, with a frontal imbalance in 6 (75 %) patients. After surgery, residual scoliosis magnitudes were from 3° to 34° (mean value – 15.3°), the frontal balance was restored in all cases. The amount of correction ranged from 49 to 90 % (mean 69.4 %). Neurological status of patients was clinically normal, deviations from the norm were insignificant and recorded only based on ENMG data. Conclusion . The use of vertebrectomy outside the apical zone in children with multiple vertebral malformations in the cervical and upper thoracic spine allows an adequate deformity correction with restoration of the spine balance, and minimizing the risk of neurological complications due to the leading compression maneuver of correction. This reduces the area of instrumental fixation, which is important for maintaining axial growth.