Posterior-only Hemivertebra Resection for Congenital Cervicothoracic Scoliosis Correcting Neck Tilt and Balancing the Shoulders

被引：43

作者：

Chen, Zhonghui ^{[1
]}

Qiu, Yong ^{[1
]}

Zhu, Zezhang ^{[1
]}

Li, Song ^{[1
]}

Chen, Xi ^{[2
]}

Xu, Liang ^{[1
]}

Sun, Xu ^{[1
]}

机构：

[1] Nanjing Univ, Med Sch, Spine Surg, Drum Tower Hosp, Zhongshan Rd 321, Nanjing 210008, Jiangsu, Peoples R China

[2] Nanjing Med Univ, Drum Tower Hosp, Spine Surg, Nanjing, Jiangsu, Peoples R China

来源：

SPINE | 2018年 / 43卷 / 06期

基金：

中国国家自然科学基金;

关键词：

cervicothoracic scoliosis; hemivertebra resection; instrumentation; posterior-only; SIMULTANEOUS ANTERIOR; IDIOPATHIC SCOLIOSIS; PEDICLE SCREWS; CERVICAL-SPINE; FOLLOW-UP; EXCISION; CHILDREN; DEFORMITY; FUSION; INSTRUMENTATION;

D O I：

10.1097/BRS.0000000000002325

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Study Design. A retrospective study. Objective. To evaluate radiographic and cosmetic outcomes after posterior-only cervicothoracic hemivertebra resection and instrumentation. Summary of Background Data. Cervicothoracic hemivertebra is a rare congenital deformity. It locates between the mobile cervical spine and the fixed thoracic spine, leading to rapid curve progression, shoulder imbalance, fixed torticollis, and facial asymmetry. Methods. This study reviewed a consecutive series of 18 patients with cervicothoracic hemivertebra. All received posterior-only hemivertebra resection and instrumentation and had a minimum follow up of 2 years. Assessments on radiographic and cosmetic outcomes were based on changes in measurements of scoliosis, shoulder balance, neck tilt, head shift, and sagittal profiles. Results. There were 24 hemivertebrae, consisting of 16 fully segmented and 8 semisegmented. Mean age at surgery was 9.5 +/- 3.1 years, and mean follow up was 32 +/- 10 months. Mean fusion segments were 4.8 +/- 0.6 segments. Operation time averaged 208 +/- 33 minutes, with an average blood loss of 384 +/- 40mL. Local scoliosis was corrected from 39 +/- 58 to 16 +/- 48 (P < 0.001). The distal curve had a spontaneous correction of 41 +/- 18%. With regards to shoulder balance, both T1 tilt and clavicle angle were significantly improved, with a correction rate of 55 +/- 22% and 47 +/- 32%, respectively. Accordingly, neck tilt was improved from 20 +/- 7 degrees to 11 +/- 7 degrees, and head shift from 22 +/- 9mm to 13 +/- 8 mm. A remarkable pedicle screw malpositioning rate (20%) was observed, but no neurovascular injuries. One case developed with Horner syndrome, and another one had transient radicular pain on the right arm after surgery. Conclusion. For patients with congenital cervicothoracic scoliosis, posterior-only hemivertebra resection with instrumentation allows for excellent scoliosis correction and cosmetic improvement. Great care should be taken to reduce the rate of pedicle screw malpositioning.

引用

页码：394 / 401

页数：8

共 29 条

[11] Computed tomography evaluation of pedicle screws placed in the pediatric deformed spine over an 8-year period [J].

Lehman, Ronald A. ;

Lenke, Lawrence G. ;

Keeler, Kathryn A. ;

Kim, Yongjung J. ;

Cheh, Gene .

SPINE, 2007, 32 (24) :2679-2684

[12] Cervical deformity - Rationale for selecting the appropriate fusion technique (anterior, posterior, and 360 degree) [J].

Liew, SM ;

Simmons, ED .

ORTHOPEDIC CLINICS OF NORTH AMERICA, 1998, 29 (04) :779-+

[13] Radiographic Assessment of Shoulder Position in 619 Idiopathic Scoliosis Patients: Can T1 Tilt Be Used as an Intraoperative Proxy to Determine Postoperative Shoulder Balance? [J].

Luhmann, Scott J. ;

Sucato, Dan J. ;

Johnston, Charles E. ;

Richards, B. Stephens ;

Karol, Lori A. .

JOURNAL OF PEDIATRIC ORTHOPAEDICS, 2016, 36 (07) :691-694

[14] Cervical vertebral anomalies in patients with anomalies of the head and neck [J].

Manaligod, JM ;

Bauman, NM ;

Menezes, AH ;

Smith, RJH .

ANNALS OF OTOLOGY RHINOLOGY AND LARYNGOLOGY, 1999, 108 (10) :925-933

[15] Single-stage excision of hemivertebrae via the posterior approach alone for congenital spine deformity -: Follow-up period longer than ten years [J].

Nakamura, H ;

Matsuda, H ;

Konishi, S ;

Yamano, Y .

SPINE, 2002, 27 (01) :110-115

[16] Circumferential convex growth arrest by posterior approach for double cervicothoracic curves in congenital scoliosis [J].

Obeid, Ibrahim ;

Taieb, Ayman ;

Vital, Jean-Marc .

EUROPEAN SPINE JOURNAL, 2013, 22 (09) :2126-2129

[17] Are breech rates for pedicle screws higher in the upper thoracic spine? [J].

Privitera D.M. ;

Matsumoto H. ;

Gomez J.A. ;

Roye Jr. D.P. ;

Hyman J.E. ;

Vitale M.G. .

Spine Deformity, 2013, 1 (3) :189-195

[18] Discrepancy between radiographic shoulder balance and cosmetic shoulder balance in adolescent idiopathic scoliosis patients with double thoracic curve [J].

Qiu, Xu-sheng ;

Ma, Wei-wei ;

Li, Wei-guo ;

Wang, Bin ;

Yu, Yang ;

Zhu, Ze-zhang ;

Qian, Bang-ping ;

Zhu, Feng ;

Sun, Xu ;

Ng, Bobby K. W. ;

Cheng, Jack C. Y. ;

Qiu, Yong .

EUROPEAN SPINE JOURNAL, 2009, 18 (01) :45-51

[19] Hemivertebra resection in the cervical spine [J].

Ruf, M ;

Jensen, R ;

Harms, J .

SPINE, 2005, 30 (04) :380-385

[20] Posterior hemivertebra resection with transpedicular instrumentation: Early correction in children aged 1 to 6 years [J].

Ruf, M ;

Harms, J .

SPINE, 2003, 28 (18) :2132-2138

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