Multiple cervical hemivertebra resection and staged thoracic pedicle subtraction osteotomy in the treatment of complicated congenital scoliosis
Multiple cervical hemivertebra resection and staged thoracic pedicle subtraction osteotomy in the treatment of complicated congenital scoliosis
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DOI：
10.1007/s00586-015-4352-9
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发表时间：
2016-05-01
影响因子：
2.8
通讯作者：
Qiu, Guixing
中科院分区：
文献类型：
--
作者：
Zhuang, Qianyu;Zhang, Jianguo;Qiu, Guixing
目的介绍我们采用多个颈椎半椎体切除和胸椎椎弓根减影截骨术（PSO）分期矫正治疗罕见且复杂的先天性脊柱侧弯的经验。方法一名14岁男性患有进行性斜颈和脊柱畸形。该畸形自出生后即出现，6个月前开始出现长时间坐着或运动后的背痛，经物理治疗无效。X线片显示右侧颈椎弯曲60度，左侧代偿性胸椎弯曲90度。三维计算机断层扫描（3D CT）显示右侧有三个半节段半椎体（C4、C5和C6）。根据我们的分期策略，三个连续的颈椎半椎体，作为主要的病理造成的畸形，首先切除联合后，前入路。结果一期手术后颈椎曲度降至23 °，胸椎曲度降至60 °，二期手术后胸椎曲度进一步降至30 °。5年随访X线片显示冠状面和矢状面平衡均得到良好恢复和稳定，枕倾角从12 °降至0 °。结论我们的策略可以为类似的多个连续颈椎半椎体和大的结构性代偿性胸椎弯曲的病例提供一种选择。这被证明在冠状面和矢状面都实现了极好的矫正，神经风险可接受。
Purpose To present our experience of staged correction with multiple cervical hemivertebra resection and thoracic pedicle subtraction osteotomy (PSO) treating a rare and complicated congenital scoliosis.Methods A 14-year-old male presented with progressive torticollis and spine deformity. The malformation developed since birth, and back pain after long-time sitting or exercise arose since 6 months before, which was unsuccessfully treated by physiotherapy. X-ray showed a right cervical curve of 60 degrees and a left compensatory thoracic curve of 90 degrees. Three-dimensional computed tomography (3D CT) scan revealed three semi-segmented hemivertebrae (C4, C5 and C6) on the right side. Based on our staged strategy, the three consecutive cervical hemivertebrae, as the major pathology causing the deformity, were firstly resected by the combined posterior and anterior approach. Six months later, T6 PSO osteotomy was used to correct the structural compensatory thoracic curve.Results The cervical curve was reduced to 23 degrees while the thoracic curve to 60 degrees after the first-stage surgery, and the thoracic curve was further reduced to 30 degrees after the second-stage surgery. The radiograph at 5-year follow-up showed that both the coronal and sagittal balance were well restored and stabilized, with the occipital tilt reduced from 12 degrees to 0 degrees.Conclusions Our strategy may provide an option for similar cases with multiple consecutive cervical hemivertebrae and a large structural compensatory thoracic curve, which proved to achieve excellent correction in both the coronal and sagittal planes with acceptable neurologic risk.