Spine-shortening osteotomy in treating congenital scoliosis with tethered cord
Shen Chao, Tao Huiren, Huang Jinghui, Li Tao, Li Feng, Yang Weizhou, Chen Bo
Published 2014-09-01
Cite as Chin J Orthop, 2014,34(09): 909-914. DOI: 10.3760/cma.j.issn.0253-2352.2014.09.004
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
Contributor Information
Shen Chao
Department of Spine Surgery, Xijing Hospital of the Fourth Military Medical University, Xi'an 710032, China
Tao Huiren
Department of Spine Surgery, Xijing Hospital of the Fourth Military Medical University, Xi'an 710032, China
Huang Jinghui
Department of Spine Surgery, Xijing Hospital of the Fourth Military Medical University, Xi'an 710032, China
Li Tao
Department of Spine Surgery, Xijing Hospital of the Fourth Military Medical University, Xi'an 710032, China
Li Feng
Department of Spine Surgery, Xijing Hospital of the Fourth Military Medical University, Xi'an 710032, China
Yang Weizhou
Department of Spine Surgery, Xijing Hospital of the Fourth Military Medical University, Xi'an 710032, China
Chen Bo
Department of Spine Surgery, Xijing Hospital of the Fourth Military Medical University, Xi'an 710032, China