Is Vertebral Column Resection Necessary in Correcting Severe and Rigid Thoracic Kyphoscoliosis? A Single-Institution Surgical Experience

BACKGROUND: Three-column spinal osteotomies were developed to address severe and stiff kyphoscoliosis. However, the optimal choice of osteotomy in these patients is still unclear. This retrospective study aims to compare the outcomes and complications between grade 4 and grade 5 osteotomies in patients with severe and stiff thoracic kyphoscoliosis. METHODS: Forty-five patients with severe and stiff thoracic kyphoscoliosis who underwent 3-column osteotomy in the thoracic spine were classified into 2 groups according to the grade of osteotomy. The clinical data and radiologic parameters were collected and compared. RESULTS: Fourteen patients received grade 4 osteotomy, and 31 patients received grade 5 osteotomy. The spinal column shortening distances were similar between groups. The postoperative and latest follow-up radiologic parameters were not statistically significant between groups. Postoperative and follow-up results demonstrated greater correction of the regional kyphosis angle in the grade 4 osteotomy group, but did not reach significant level. The operative time and blood loss of grade 5 osteotomies were greater than those of grade 4, but showed no significant differences. Perioperative complication rates were also similar between groups. CONCLUSIONS: Similar clinical outcomes can be achieved with grade 4 and grade 5 spinal osteotomies. This may enrich the basis on moving down to a lower osteotomy grade when treating patients with severe and rigid thoracic kyphoscoliosis.