ABSTRACT

Introduction:

In the literature, in order to preserve balance of the spine and to correct deformities, different types of osteotomies were described. The treatment of severe coronal and sagittal deformity using corrective osteotomies is a demanding surgical challenge especially in thoracic and thoracolumbar area. With advancement of using pedicle screws in spine surgery, more complex surgeries have become increasingly elaborate. Two staged surgery-anterior release and decompression and posterior correction was chosen as a treatment in the past. Recently, corrective osteotomies by posterior only approach has been popularized.

Materials and methods:

Retrospectively, 14 patients with kyphosis or kyphoscoliosis who underwent to total vertebral wedge resection by posterior approach were reviewed. Sagittal and coronal balance of the patients was evaluated. Age, sex, etiology of deformity, localization of deformity, preoperative and postoperative local kyphosis angle, correction magnitude in sagittal axis, preoperative and postoperative Cobb angle, intraoperative blood loss, duration of operation and neurological status were evaluated. A total of 14 patients, 9 female and 5 male, were included in this study. The average age was 24.8 (12-77). The average follow-up of the patients was 25,3 months (6-104 months). The patients who diagnosed post-traumatic kyphosis in 4 patients, congenital kyphoscoliosis in 4 patients, metastasis (breast carcinoma and gastric carcinoma) in two patients, congenital kyphosis in 1 patient, iatrogenic kyphosis in 1 patient and localized plasmacytoma in 1 patient were involved in this study. Deformity was localized to thoracic area in 7 patient, lumbar area in 1 patient, thoracolumbar area in 6 patient. Nine patients had kyphosis and 5 patients had kyphoscoliosis. Average operation time w as 5,5 hour (4-7 hour). Average blood loss was 2684cc (1800-3600cc).

Results:

The kyphosis angle was between 12°-75° preoperatively and -20°-44° postoperatively. Average correction w as 26.3°(8-46°). Patients with kyphoscoliosis, the Cobb angle was between 25-97° preoperatively and 10-52° postoperatively. The coronal correction was average 28.8°(9-45°). Sagittal plumb line was (+)110- (-)33 mm preoperatively, (+)12- (-) 7mm postoperatively. Neurologic deficit was found in 4 patients preoperatively. At most recent follow-up, the preoperative neurological compromise was improved in all patients except one.

Discussion and Conclusion:

In this study, we concluded that, with using of total vertebral wedge resection, enough correction could be obtained in combined sagittal coronal deformities.