CORRECTION OF THORACOLUMBAR KYPHOSCOLIOSIS BY MODIFIED “EGGSHELL” OSTEOTOMY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ANGYang , LIUBin ,  RONGLimin , CHENRuiqiang , DONGJianwen , XIEPeigen , ZHANGLiangming , YANGBu , SHUTao , PANGMao

Department of Spine Surgery, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou Guangdong, 510630, P. R. China;

Corresponding author：

RONGLimin, Email: ronglimin@21cn.com

Keywords：

Modified "eggshell" technique; Osteotomy; Kyphoscoliosis; Spinal deformity

DOI：

10.7507/1002-1892.20160015

Video：

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Objective To evaluate the effectiveness of modified "eggshell" osteotomy for the treatment of thoracolumbar kyphoscoliosis. Method Between April 2009 and June 2014, 19 patients with spinal deformity underwent modified "eggshell" osteotomy consisting of preserving posterior bony structures initially and enlarging surgical field for cancellous bone removal. There were 14 males and 5 females with an average age of 37.8 years (range, 18-76 years) and with a median disease duration of 7 years (range, 1-40 years). The disease causes included ankylosing spondylitis in 13 cases, spinal tuberculosis in 3 cases, and chronic vertebral compression fracture in 3 cases. Eleven patients showed single kyphosis and 8 patients had kyphoscoliosis. Preoperative Cobb angle of kyphosis was (64.2±30.1) °, while Cobb angle of scoliosis was (19.9±12.8) °. Apical vertebraes were T₁₀ in 1 case, L₁ in 3 cases, L₂ in 7 cases, T_{10, 11} in 2 cases, T₁₂, L₁ in 4 cases, T₁₂-L₂ in 1 case, and T₁₀-L₁ in 1 case. Preoperative visual analogue scale (VAS) and Japanese Orthopaedic Association (JOA) score were 6.1±1.9 and 15.2±5.6, respectively. According to Frankel criteria for spinal cord function, 16 cases were rated as grade E and 3 cases as grade D before operation. Cobb angle, VAS, and JOA scors were used to assess relief of symptom. Results The operation time was 215-610 minutes (mean, 343 minutes); intraoperative blood loss ranged from 900 to 3000 mL (mean, 1573 mL). All incisions healed primarily. Delayed onset ischemia-reperfusion injury of spinal cord occurred in 1 case at 6 days after operation, and symptoms alleviated after conservative treatments. All 19 cases were followed up 14-76 months (mean, 46 months). No loosening or breakage of internal fixation was observed during follow-up. Cobb angle of kyphosis, Cobb angle of scoliosis, VAS and JOA scores at 1 week after operation and last follow-up were significantly improved when compared with preoperative ones (P<0.05) . VAS and JOA scores at last follow-up were significantly improved when compared with scores at 1 week after operation (P<0.05) , but no significant difference was found in Cobb angle of both kyphosis and scoliosis between at 1 week after operation and at last follow-up (P>0.05) . At 1 week after operation, the correction rate for kyphosis was 34.1%-93.4% (mean, 62.2%), and the correction rate for scoliosis was 42.4%-100% (mean, 68.9%). At 48 months after operation, 3 patients with preoperative impaired spinal cord function achieved full recovery. Conclusions Modified "eggshell" osteotomy owns the advantages of shorter operation time and less intraoperative blood loss, thus it is able to correct thoracolumbar kyphoscoliosis safely and effectively.

Citation： ANGYang, LIUBin, RONGLimin, CHENRuiqiang, DONGJianwen, XIEPeigen, ZHANGLiangming, YANGBu, SHUTao, PANGMao. CORRECTION OF THORACOLUMBAR KYPHOSCOLIOSIS BY MODIFIED “EGGSHELL” OSTEOTOMY. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(1): 72-76. doi: 10.7507/1002-1892.20160015 Copy

1.	Murrey DB, Brigham CD, Kiebzak GM, et al. Transpedicular decompression and pedicle subtraction osteotomy (eggshell procedure):a retrospective review of 59 patients. Spine (Phila Pa 1976) , 2002, 27(21) :2338-2345.
2.	McMaster MJ, Singh H. The surgical management of congenital kyphosis and kyphoscoliosis. Spine (Phila Pa 1976) , 2001, 26(19) :2146-2154.
3.	Mikles MR, Graziano GP, Hensinger AR. Transpedicular eggshell osteotomies for congenital scoliosis using frameless stereotactic guidance. Spine (Phila Pa 1976) , 2001, 26(20) :2289-2296.
4.	Danisa OA, Turner D, Richardson WJ. Surgical correction of lumbar kyphotic deformity:posterior reduction "eggshell" osteotomy. J Neurosurg, 2000, 92(1 Suppl):50-56.
5.	王岩,张雪松,张永刚,等.后路扩大"蛋壳"技术行畸形脊椎切除矫治重度成人先天性脊柱侧后凸.中国脊柱脊髓杂志, 2006, 16(9) :655-658.
6.	刘新宇,原所茂,田永昊,等.扩大"蛋壳"结合治疗胸腰椎角闭合-张开技术治疗胸腰椎角状后凸畸形.中国脊柱脊髓杂志, 2014, 24(9) :779-783.
7.	Boachie-Adjei O. Role and technique of eggshell osteotomies and vertebral column resections in the treatment of fixed sagittal imbalance. Instr Course Lect, 2006, 55:583-589.
8.	Wang Y, Zhang Y, Zhang X, et al. A single posterior approach for multilevel modified vertebral column resection in adults with severe rigid congenital kyphoscoliosis:a retrospective study of 13 cases. Eur Spine J, 2008, 17(3) :361-372.
9.	Li F, Sagi HC, Liu B, et al. Comparative evaluation of single-level closing-wedge vertebral osteotomies for the correction of fixed kyphotic deformity of the lumbar spine:a cadaveric study. Spine (Phila Pa 1976) , 2001, 26(21) :2385-2391.
10.	郑国权,王岩,张永刚,等.扩大"蛋壳"技术治疗100°以上重度特发性脊柱侧凸畸形.脊柱外科杂志, 2010, 8(2) :71-74.
11.	Othman Z, Lenke LG, Bolon SM, et al. Hypotension-induced loss of intraoperative monitoring data during surgical correction of scheuermann kyphosis:a case report. Spine (Phila Pa 1976) , 2004, 29(12) :E258-265.
12.	Min K, Hahn F, Leonardi M. Lumbar spinal osteotomy for kyphosis in ankylosing spondylitis:the significance of the whole body kyphosis angle. J Spinal Disord Tech, 2007, 20(2) :149-153.
13.	叶启彬,匡正达,杜明奎,等.脊柱后凸畸形外科治疗的进展与问题.中国矫形外科杂志, 2011, 19(1) :7-10.
14.	Voos K, Boachie-Adjei O, Rawlins BA. Multiple vertebral osteotomies in the treatment of rigid adult spine deformities. Spine (Phila Pa 1976) , 2001, 26(5) :526-533.
15.	Grob D, Daehn S, Mannion AF. Titanium mesh cages (TMC) in spine surgery. Eur Spine J, 2005, 14(3) :211-221.
16.	Keyoung HM, Kanter AS, Mummaneni PV. Delayed-onset neurological deficit following correction of severe thoracic kyphotic deformity. J Neurosurg Spine, 2008, 8(1) :74-79.
17.	Hojo Y, Ito M, Abumi K, et al. A late neurological complication following posterior correction surgery of severe cervical kyphosis. Eur Spine J, 2011, 20(6) :890-898.
18.	朱守荣,刘郑生,侯克东,等.脊柱手术后迟发脊髓损伤的早期诊断和治疗.中国脊柱脊髓杂志, 2006, 16(增刊):20-21.

1. Murrey DB, Brigham CD, Kiebzak GM, et al. Transpedicular decompression and pedicle subtraction osteotomy (eggshell procedure):a retrospective review of 59 patients. Spine (Phila Pa 1976) , 2002, 27(21) :2338-2345.
2. McMaster MJ, Singh H. The surgical management of congenital kyphosis and kyphoscoliosis. Spine (Phila Pa 1976) , 2001, 26(19) :2146-2154.
3. Mikles MR, Graziano GP, Hensinger AR. Transpedicular eggshell osteotomies for congenital scoliosis using frameless stereotactic guidance. Spine (Phila Pa 1976) , 2001, 26(20) :2289-2296.
4. Danisa OA, Turner D, Richardson WJ. Surgical correction of lumbar kyphotic deformity:posterior reduction "eggshell" osteotomy. J Neurosurg, 2000, 92(1 Suppl):50-56.
5. 王岩,张雪松,张永刚,等.后路扩大"蛋壳"技术行畸形脊椎切除矫治重度成人先天性脊柱侧后凸.中国脊柱脊髓杂志, 2006, 16(9) :655-658.
6. 刘新宇,原所茂,田永昊,等.扩大"蛋壳"结合治疗胸腰椎角闭合-张开技术治疗胸腰椎角状后凸畸形.中国脊柱脊髓杂志, 2014, 24(9) :779-783.
7. Boachie-Adjei O. Role and technique of eggshell osteotomies and vertebral column resections in the treatment of fixed sagittal imbalance. Instr Course Lect, 2006, 55:583-589.
8. Wang Y, Zhang Y, Zhang X, et al. A single posterior approach for multilevel modified vertebral column resection in adults with severe rigid congenital kyphoscoliosis:a retrospective study of 13 cases. Eur Spine J, 2008, 17(3) :361-372.
9. Li F, Sagi HC, Liu B, et al. Comparative evaluation of single-level closing-wedge vertebral osteotomies for the correction of fixed kyphotic deformity of the lumbar spine:a cadaveric study. Spine (Phila Pa 1976) , 2001, 26(21) :2385-2391.
10. 郑国权,王岩,张永刚,等.扩大"蛋壳"技术治疗100°以上重度特发性脊柱侧凸畸形.脊柱外科杂志, 2010, 8(2) :71-74.
11. Othman Z, Lenke LG, Bolon SM, et al. Hypotension-induced loss of intraoperative monitoring data during surgical correction of scheuermann kyphosis:a case report. Spine (Phila Pa 1976) , 2004, 29(12) :E258-265.
12. Min K, Hahn F, Leonardi M. Lumbar spinal osteotomy for kyphosis in ankylosing spondylitis:the significance of the whole body kyphosis angle. J Spinal Disord Tech, 2007, 20(2) :149-153.
13. 叶启彬,匡正达,杜明奎,等.脊柱后凸畸形外科治疗的进展与问题.中国矫形外科杂志, 2011, 19(1) :7-10.
14. Voos K, Boachie-Adjei O, Rawlins BA. Multiple vertebral osteotomies in the treatment of rigid adult spine deformities. Spine (Phila Pa 1976) , 2001, 26(5) :526-533.
15. Grob D, Daehn S, Mannion AF. Titanium mesh cages (TMC) in spine surgery. Eur Spine J, 2005, 14(3) :211-221.
16. Keyoung HM, Kanter AS, Mummaneni PV. Delayed-onset neurological deficit following correction of severe thoracic kyphotic deformity. J Neurosurg Spine, 2008, 8(1) :74-79.
17. Hojo Y, Ito M, Abumi K, et al. A late neurological complication following posterior correction surgery of severe cervical kyphosis. Eur Spine J, 2011, 20(6) :890-898.
18. 朱守荣,刘郑生,侯克东,等.脊柱手术后迟发脊髓损伤的早期诊断和治疗.中国脊柱脊髓杂志, 2006, 16(增刊):20-21.

Chinese Journal of Reparative and Reconstructive Surgery

CORRECTION OF THORACOLUMBAR KYPHOSCOLIOSIS BY MODIFIED “EGGSHELL” OSTEOTOMY

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