Wedge Resection Osteotomy Research Articles

Technique tip: 3D printing surgical guide for pes cavus midfoot osteotomy

BackgroundPes cavus can be defined as an abnormal elevation of the longitudinal arches, which is often secondary to a muscle imbalance. This deformity affects the foot’s three dimensions (3D) and our osteotomies are usually planned on a lateral (two-dimension) X-ray. Are we really considering all the spatial components of the deformity? The aim of this study is to present a technique tip to identify the apical plane of the pes cavus deformity and perform a midfoot dorsal-based wedge resection osteotomy by using customized 3D printed surgical guides. MethodsThree patients underwent the presented technique, all for the indication of symptomatic neuromuscular pes cavus with both anterior and posterior deformity. Results3D-printed patient-specific guides help the surgeon to minimize human error, improving intraoperative accuracy, while reducing surgical time and intraoperative X-ray exposure. ConclusionsClosing wedge midfoot osteotomy to correct anterior pes cavus may be an interesting indication to use customized 3D printed surgical guides.

226. Sequential correction of the severe and rigid thoracic kyphoscoliosis: a new technical note and preliminary results

BACKGROUND CONTEXT Although posterior vertebral column resection has traditionally been used to correct severe and rigid kyphoscoliosis, sequential correction combined with transpedicular wedge resection osteotomy may achieve the same correction with a shorter operative time and lower rate of complications. PURPOSE To determine the efficacy of a new sequential correction technique combined with transpedicular wedge resection osteotomy for severe and rigid thoracic kyphoscoliosis STUDY DESIGN/SETTING Retrospective analysis of clinical records. PATIENT SAMPLE Between May 2011 and December 2017, 16 adults were included in the present study. OUTCOME MEASURES Radiological measurements, including coronal plane major curve, kyphotic curve, coronal offset, and sagittal offset, were measured and compared. The following patient-reported health-related quality of life outcomes, including Oswestry Disability Index score, visual analog scale (VAS) score for back pain, and SRS-22 questionnaire, were used to evaluate the clinical outcomes. METHODS All the patients included underwent a transpedicular wedge resection osteotomy of the apical vertebrae for severe and rigid thoracic kyphoscoliosis and sequential correction. Stepwise closing of the osteotomy sites was performed with two short rods, then cantilever reduction maneuver was performed with concave side short rod preserved. RESULTS All these patients were followed over 24 months, the mean coronal plane major curve improved from 115.2±29.0° to 43.1±15.5° immediately after surgery and to 45.5±15.1° at 24 months postoperatively. The mean kyphotic curve improved from 99.6±33.1° to 32.1±19.7° immediately after surgery and to 33.9±19.0° at 24 months postoperatively. The mean coronal offset and sagittal offset were also improved. Improved self-reported quality of life scores were achieved postoperatively and at 24 months postoperatively, including all domains of the SRS-22 questionnaire. Bony fusion was achieved at 6 or 12 months in all patients. Unilateral leg paresis occurred in one case and recovered after three months, with a neurological complication rate of 6.2%. CONCLUSIONS The sequential correction technique combined with transpedicular wedge resection osteotomy is an excellent treatment for severe and rigid thoracic kyphoscoliosis in adult patients provided excellent clinical outcomes. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Transcervical superior wedge resection (osteotomy) and fixation with contoured plate for the non- union of femoral neck fractures.

Study was conducted to determine the healing rate of non-union femoral neck fractures following a new transcervical superior based wedge resection and fixation with contoured plate. This study is based on a concept, that the presence of a residual part of the femoral neck on the trochanteric side of the non-union and removal of a wedge with a superior base not only converts shearing forces into compression forces but also provides fresh bone with an osteogenic potential. This is a descriptive case series 'one group pre-test post-test design', conducted from 2010 to 2016 with a sample size of 18, convenience sampling technique with a minimum follow up of 12 months. Eighteen patients with a mean age of 32.44±8.8 years were operated with transcervical wedge resection and fixation. However, only 14 completed a minimum follow up of twelve months. Thirteen (93%) patients achieved union while, one had stable fibrous union which later on developed avascular necrosis and underwent a total hip replacement. There was a mean shortening of 2.05±0.4 cm. Seven (50%) had post-operative Lurch and 4 (28.6%) required shoe raise while 1 had low grade infection.

Transpedicular Wedge Resection Osteotomy of the Apical Vertebrae for the Treatment of Severe and Rigid Thoracic Kyphoscoliosis: A Retrospective Study of 26 Cases

Study DesignRetrospective analysis of clinical records. ObjectiveTo determine the efficacy of transpedicular wedge resection osteotomy (TWRO) of the apical vertebrae to treat severe and rigid thoracic kyphoscoliosis in 26 adults. Summary of Background DataAlthough posterior vertebral column resection has traditionally been used to correct severe and rigid kyphoscoliosis, TWRO may achieve the same correction with a shorter operative time and lower rate of complications. MethodsBetween May 2011 and December 2014, 29 adults underwent a TWRO of the apical vertebrae for severe and rigid thoracic kyphoscoliosis, and 26 adults completed the 24-month follow-up. Radiologic measurements, including coronal plane major curve, kyphotic curve, coronal offset, and sagittal offset, were measured and compared. The following patient-reported health-related quality of life outcomes, including Oswestry Disability Index score, visual analog scale score for back pain, and SRS-22 questionnaire, were used to evaluate the clinical outcomes. ResultsFor the 26 patients followed over 24 months, the mean coronal plane major curve improved from 107.6° to 37.5° immediately after surgery and to 40.0° at 24 months postoperatively. The mean kyphotic curve improved from 90.6° to 30.5° immediately after surgery and to 33.3° at 24 months postoperatively. The mean coronal offset and sagittal offset were also improved. Improved self-reported quality of life scores were achieved postoperatively and at 24 months postoperatively, including all domains of the SRS-22 questionnaire. Bony fusion was achieved at 6 or 12 months in all patients. Unilateral leg paresis occurred in one case and recovered after three months, with a neurologic complication rate of 3.8%. ConclusionsTWRO of the apical vertebrae as a treatment for severe and rigid thoracic kyphoscoliosis in adult patients provided excellent clinical outcomes. However, the procedure remains technically demanding and exhausting, with a potential risk for complications. Level of EvidenceLevel IV.

Transpedicular lumbar wedge resection osteotomy for correction of kyphosis in ankylosing spondylitis

Objective To explore the clinical efficacies of transpedicular lumbar wedge resection osteotomy for correction of kyphosis in ankylosing spondylitis.Methods From January 2005 to March 2010,32 patients with ankylosing spondylitis kyphotic deformity received one stage posterior transpedicular wedge osteotomy and internal fixation,with 27 receiving single-level ones and 5 receiving two-level ones.All patients underwent X-ray examination of the total spine to obtain radiographic parameters and were asked to accomplish simplified Chinese scoliosis research society-22(SRS-22) questionnaire to assess quality of health before and after operation.Results The mean operation time was(260±42) min and the mean blood loss was(1 360±282) mL in the patients.The patients were followed up for a mean of(31±8) months(range: 24-76 months) and there were no neurological complications and pseudarthrosis.The chin-brow vertical angle(CBVA),global thoraco-lumber kyphosis angle(TLKA),thoracolumbar kyphosis angle(TKA) and lumber lordosis angle(LLA) were(65.9±11.6)°,(78.2±15.9)°,(38.9±10.3)°,and(-14.6±17.3)° before operation and(11.7±4.7)°,(38.9±10.3)°,(1.3±7.8)°,and(26.2±5.6)° after operation,respectively;and significant differences were found for each parameter(P0.01).The body height and the sagittal imbalance distance were improved from(135.4±15.2) cm and(37.2±11.3) cm before operation to(166.2±9.6) cm and(12.7±7.7) cm after operation,respectively.The average SRS-22 score increased from(1.8±0.4) before operation to(4.0±0.6) after operation,showing a satisfactory outcome.Conclusion Transpedicular lumbar wedge resection osteotomy is a safe and effective method for treatment of the ankylosing spondylitis kyphosis.

The clinical outcomes of surgical treatment for adult idiopathic scoliosis using pedicle subtraction osteotomy

to evaluate the clinical outcomes of transpedicular lumbar wedge resection osteotomy in treating adult idiopathic scoliosis. twenty-five adult idiopathic scoliosis patients treated with transpedicular lumbar wedge resection osteotomy from July 2001 to November 2007 were included, among whom 18 were female and 7 were male. Nine of 25 were with double major curve in thoracic and thoracolumbar/lumbar spine, and 16 were with single curve in thoracolumbar/lumbar spine. The average age was 35 years (29 - 48 years) at operation. Osteotomy were performed at T(11), T(12), L(1) or L(2). The motion evoked potential monitoring system and awaking test were used during surgery. The preoperative, postoperative immediately and latest standing posteroanterior and lateral radiographs were reviewed. all patients were operated successfully. The average operation time was 274 min (range, 220 - 380 min) and the average blood loss were 2328 ml (range, 1500 - 5000 ml). The average coronal Cobb angle of all patients in thoracolumbar/lumbar curves was 88° (range, 70° - 121°) before operation, which was corrected to 43° (range, 35° - 70°). The coronal correction rate was 44%. The average kyphosis angle of all in thoracolumbar/lumbar curves was 63° (range, 50° - 90°) before operation, which was corrected to 10° (range, -40° - 21°). The sagittal correction rate was 86%. Nerve root injury occurred in 3 of all patients who complained about postoperative radicular pain. No spine cord injury, delayed paralysis, infection and instrumentation failure were found. With a follow-up of 2 - 4 years, no correction loss or decompensation happened. The back pain existing before operation was relieved in large measure. The cosmetic appearance were all promoted significantly. the transpedicular thoracolumbar/lumbar wedge osteotomy is efficient and safe in the correction of adult idiopathic scoliosis. The correction is much better on the sagittal plane than that on the coronal plane.

Lumbar Wedge Resection Osteotomy for Congenital Scoliosis due to a Sacral Malformation - A Case Report -

Congenital scoliosis due to a sacral malformation is quite rare. To the best of our knowledge, most wedge resection osteotomies have been performed to correct a kyphotic deformity in ankylosing spondylitis. However, there is no report of a trapezoidal lumbar wedge resection osteotomy of the vertebral body in the surgical treatment of congenital scoliosis due to a sacral malformation. This paper reports a 41-year-old female with a 25-year history of lower back and buttock pain combined with radiating pain to the lower extremities. The coronal imbalance was 3.8 cm and the scoliosis angle using the Cobb method was 22˚. A trapezoidal wedge resection osteotomy of the L5 body was performed, and the scoliosis was corrected. We detail this modification of a vertebral osteotomy technique and show that a fixed coronal deformity could be corrected effectively using this technique.

Transpedicular Lumbar Wedge Resection Osteotomy for Fixed Sagittal Imbalance

A retrospective consecutive case series, radiographic analysis, outcomes analysis, and report on complications. To evaluate the radiographic and functional outcomes of a reconstructive realignment procedure for fixed sagittal imbalance and discuss the complications. We describe a modification of an existing technique permitting greater single-level correction for which no reports exist in the peer-reviewed literature. Twenty-four patients were eligible for 2-year minimum follow-up (average, 4.0 years). Etiologies included iatrogenic (n = 17), post-traumatic (n = 3), ankylosing spondylitis (n = 2), degenerative (n = 1), and congenital (n = 1). Patients were evaluated by standardized upright radiographs, chart review, and National Spine Network questionnaire. Seventeen patients had undergone 17 previous procedures. Seven of 24 patients required augmentation with anterior structural grafting. The majority of osteotomies were performed at L3 (15); others included L2 (6), L4 (2), and L5 (1). Lumbar lordosis before surgery averaged 13 degrees (range, 55 degrees to -65 degrees) and improved to 53 degrees (range, 20 degrees to 99 degrees), an average correction of 40%. The sagittal vertical axis measured from C7-S1 demonstrated a preoperative sagittal decompensation averaging 11.4 cm (range, 5.5-23 cm) with correction to 2.4 cm (-9.0 cm or 79% average correction). Coronal balance did not change significantly. There were 17 complications in 14 patients. Nine patients required additional surgery at latest follow-up. Transpedicular wedge resection osteotomy procedure is a very effective technique to correct fixed sagittal imbalance and provide biomechanical stability. The high complication rate mandates a careful assessment of the risk/benefit ratio before undertaking what is a major reconstructive procedure. Most patients are satisfied, particularly when sagittal balance is achieved.

Transpedicular wedge resection osteotomy for the treatment of a kyphotic Andersson lesion-complicating ankylosing spondylitis

Two cases with a long-standing thoracolumbar kyphosis due to ankylosing spondylitis are presented with a symptomatic localized destructive kyphotic lesion of the spine. Clinical and radiographic findings demonstrated a progressive vertebral and discovertebral kyphotic pseudarthrosis, known as an Andersson lesion, at the L1 and L1-2 level, respectively. Surgical correction and stabilization was performed by an extending transpedicular wedge resection osteotomy to restore spinal stability, to facilitate fracture healing as well as to restore the sagittal balance of the ankylosed spine. To predict the effect of a surgical correction of the Andersson lesion on the sagittal balance, deformity planning was performed preoperatively. The indication for surgery, the surgical technique and the 2 years' clinical results are described. In addition, the difficulties experienced with preoperative deformity planning are evaluated.

Surgical correction of kyphosis: posterior total wedge resection osteotomy in 32 patients.

Many surgical procedures have been developed for the treatment of kyphoscoliosis. We present our experience of one technique for posterior total wedge resection osteotomy, with clinical and radiographic results. This is a one-stage solution which results in a shortened posterior column and reduced tension on the spinal cord in rigid angular kyphosis. Between 1990 and 2000, we treated 32 patients with rigid local kyphosis by posterior wedge osteotomy and instrumentation. The etiology was congenital malformation in 17 cases, infection in 11 and previous laminectomy in 4 cases. The osteotomy is performed at the apex of the kyphotic deformity and covers two vertebrae. The upper and lower borders of the osteotomy are right inferior to the transverse processes of the upper and lower vertebrae respectively. The apex of the posteriorly based triangular osteotomy is either at the anterior vertebral body or anterior longitudinal ligament. The mean preoperative angle of local kyphosis was 72 (25-112) degrees mainly at the thoracolumbar region, and it improved to a mean of 23 (0-48) degrees after an average follow-up of 57 (24-108) months. The mean preoperative sagittal plumbline imbalance of 5.5 (2-12) cm was improved to 1.2 (-2-3.5) cm postoperatively. The mean loss of correction since operation was 3.4 (0-11) degrees. Radiographically, solid anterior and posterior fusion was achieved in all patients by 6 months. 1 patient had irreversible paraplegia and 2 others had transient nerve root injury postoperatively. Posterior total wedge resection osteotomy eliminates the need for anterior procedure and does not cause tractional force on the spinal cord, since the posterior column is shortened. This is an effective one-stage procedure, especially for the treatment of sharp and rigid kyphosis.

Management of fixed sagittal plane deformity: results of the transpedicular wedge resection osteotomy.

Retrospective review of a consecutive clinical series. To evaluate the efficacy of the transpedicular wedge resection osteotomy as a technique for correction of sagittal and coronal deformity and to assess the clinical value of the procedure as assessed by patient satisfaction. The transpedicular wedge resection osteotomy is a well-established procedure for management of fixed sagittal deformity in ankylosing spondylitis. The utility of the procedure for applications in fixed deformity other than ankylosing spondylitis has not been demonstrated, and the efficacy of the procedure in the correction of coronal deformity has not been reported. A total of 13 consecutive cases undergoing transpedicular wedge resection osteotomy for the management of sagittal deformity of any etiology were reviewed. Radiographic studies, complications, and satisfaction assessment using the modified Scoliosis Research Society instrument were the outcome parameters measured. Etiologies of deformity included postsurgical, ankylosing spondylitis, idiopathic, and infectious. Measurement of C7 sagittal plumb line to sacrum improved 63% at the most recent follow-up. Lumbar lordosis increased from -15.5 degrees to -45.4 degrees. Coronal balance was improved in all patients who had preoperative imbalance, with an average improvement of 60% maintained at follow-up. Patient satisfaction was high in all patients and not dependent on the etiology of deformity. The transpedicular wedge resection osteotomy is an effective procedure for the management of fixed sagittal deformity and is generalizable for multiple etiologies. Simultaneous correction of coronal deformity is possible. The clinical value of the procedure is demonstrated in high rates of patient satisfaction.