European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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The treatment of rigid and severe scoliosis and kyphoscoliosis is a surgical challenge. Presurgical halo-gravity traction (HGT) achieves an increase in curve flexibility, a reduction in neurologic risks through gradual traction on a chronically tethered cord and an improvement in preoperative pulmonary function. However, little is known with respect to the ideal indications for HGT, its appropriate duration, or its efficacy in the treatment of rigid deformities. ⋯ The improvement of pulmonary function and the restoration of sagittal and coronal balance are the main goals in the treatment of severe and rigid scoliosis and kyphoscoliosis. A review of the literature showed that HGT is a useful tool for selected patients. Preoperative HGT is indicated in severe curves with moderate to severe pulmonary compromise. HGT should not be expected to significantly improve severe curves without a prior anterior and/or posterior release. The data presented in this study can be used in future studies to compare the surgical and pulmonary outcomes of severe and rigid deformities.
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Comparative Study
Hemivertebra resection in children, results after single posterior approach and after combined anterior and posterior approach: a comparative study.
To compare the results after hemivertebra resection through a single posterior approach and through a combined anterior and posterior approach. ⋯ Similar correction of the main and the compensatory curves can be achieved with single posterior and combined anterior and posterior hemivertebra resection. Benefits of the SPA are lower complication rate and shorter recovery period.
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Video-assisted thoracoscopic surgery (VATS) has been developed for surgical treatment of thoracic spinal tuberculosis to overcome the problems associated with a formal thoracotomy. VATS, however, is technically demanding with a difficult learning curve. ⋯ Thoracoscopy-assisted mini-open approach can provide a simple, safe, and practical treatment option with minimal invasiveness in cases of thoracic spinal tuberculosis. Successful clinical and radiographic outcomes can be achieved via anterior debridement and reconstruction at long-term follow-up.
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Restoration of the anterior spinal profile and regular load-bearing is the main goal treating anterior spinal defects in case of fracture. Over the past years, development and clinical usage of cages for vertebral body replacement have increased rapidly. For an enhanced stabilization of rotationally unstable fractures, additional antero-lateral implants are common. The purpose of this study was the evaluation of the biomechanical behaviour of a recently modified, in situ distractible vertebral body replacement (VBR) combined with a newly developed antero-lateral polyaxial plate and/or pedicle screws and rods using a full corpectomy model as fracture simulation. ⋯ For rotationally unstable vertebral body fractures, only combined antero-posterior instrumentation could significantly decrease the range of motion (ROM) in all motion planes compared to the intact state.
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Congenital scoliosis with unilateral unsegmented bar has remained a surgical challenge. If it is treated with a traditional release of the convex side and an apical wedge osteotomy, there is a risk of bony bridge fracture on the concave side and spine translation during correction maneuvers, which may then result in spinal cord injuries. The authors developed a technique that consists of a concave-side costovertebral joint release followed by both-ends wedge osteotomy via a posterior-only approach. In this article, we describe the technique in detail, and present the results of ten patients treated with this technique. ⋯ We have had good results with our technique of concave-side costovertebral joint release and both-end wedge osteotomy. It has the advantage of remnant anulus fibrosus, the ligamentum flavum, and the facet joints on the concave side serving both as a hinge and to minimize translation of the spine ends. It can provide excellent three-dimensional curve correction for patients with severe rigid congenital scoliosis with unilateral unsegmented bar.