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Multiple cervical hemivertebra resection and staged thoracic pedicle subtraction osteotomy in the treatment of complicated congenital scoliosis

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Abstract

Purpose

To present our experience of staged correction with multiple cervical hemivertebra resection and thoracic pedicle subtraction osteotomy (PSO) treating a rare and complicated congenital scoliosis.

Methods

A 14-year-old male presented with progressive torticollis and spine deformity. The malformation developed since birth, and back pain after long-time sitting or exercise arose since 6 months before, which was unsuccessfully treated by physiotherapy. X-ray showed a right cervical curve of 60° and a left compensatory thoracic curve of 90°. Three-dimensional computed tomography (3-D CT) scan revealed three semi-segmented hemivertebrae (C4, C5 and C6) on the right side. Based on our staged strategy, the three consecutive cervical hemivertebrae, as the major pathology causing the deformity, were firstly resected by the combined posterior and anterior approach. Six months later, T6 PSO osteotomy was used to correct the structural compensatory thoracic curve.

Results

The cervical curve was reduced to 23° while the thoracic curve to 60° after the first-stage surgery, and the thoracic curve was further reduced to 30° after the second-stage surgery. The radiograph at 5-year follow-up showed that both the coronal and sagittal balance were well restored and stabilized, with the occipital tilt reduced from 12° to 0°.

Conclusions

Our strategy may provide an option for similar cases with multiple consecutive cervical hemivertebrae and a large structural compensatory thoracic curve, which proved to achieve excellent correction in both the coronal and sagittal planes with acceptable neurologic risk.

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References

  1. Klimo P Jr, Rao G, Brockmeyer D (2007) Congenital anomalies of the cervical spine. Neurosurg Clin N Am 18:463–478

    Article  PubMed  Google Scholar 

  2. Smith MD (1994) Congenital scoliosis of the cervical or cervicothoracic spine. Orthop Clin North Am 25:301–310

    CAS  PubMed  Google Scholar 

  3. Dubousset J (1986) Torticollis in children caused by congenital anomalies of the atlas. J Bone Joint Surg Am 68:178–188

    CAS  PubMed  Google Scholar 

  4. Samartzis D, Kalluri P, Herman J, Lubicky JP, Shen FH (2011) Cervical scoliosis in the Klippel–Feil patient. Spine (Phila Pa 1976) 36:E1501–E1508

    Article  Google Scholar 

  5. Nasca RJ, Stilling FH 3rd, Stell HH (1975) Progression of congenital scoliosis due to hemivertebrae and hemivertebrae with bars. J Bone Joint Surg Am 57:456–466

    CAS  PubMed  Google Scholar 

  6. Liew SM, Simmons ED Jr (1998) Cervical deformity: rationale for selecting the appropriate fusion technique (anterior, posterior, and 360 degree). Orthop Clin N Am 29:779–786

    Article  CAS  Google Scholar 

  7. Deburge A, Briard JL (1981) Cervical hemivertebra excision. J Bone Joint Surg Am 63:1335–1339

    CAS  PubMed  Google Scholar 

  8. Ruf M, Jensen R, Harms J (2005) Hemivertebra resection in the cervical spine. Spine (Phila Pa 1976) 30:380–385

    Article  Google Scholar 

  9. Obeid I, Bourghli A, Vital JM (2012) Pedicle subtraction osteotomy for postoperative flat back and sagittal imbalance. Eur Spine J 21:1218–1219

    Article  PubMed  Google Scholar 

  10. Le Huec JC, Aunoble S (2012) Pedicle subtraction osteotomy for sagittal imbalance. Eur Spine J 21:1896–1897

    Article  PubMed  PubMed Central  Google Scholar 

  11. Caruso L, Barone G, Farneti A, Caraffa A (2014) Pedicle subtraction osteotomy for the treatment of chin-on-chest deformity in a post-radiotherapy dropped head syndrome: a case report and review of literature. Eur Spine J 23(Suppl 6):634–643

    Article  PubMed  Google Scholar 

  12. Truumees E, Herkowitz HN (2000) Cervical spondylotic myelopathy and radiculopathy. Instr Course Lect 49:339–360

    CAS  PubMed  Google Scholar 

  13. Lebl DR, Bono CM (2015) Update on the diagnosis and management of cervical spondylotic myelopathy. J Am Acad Orthop Surg 23:648–660

    Article  PubMed  Google Scholar 

  14. Baron EM, Young WF (2007) Cervical spondylotic myelopathy: a brief review of its pathophysiology, clinical course, and diagnosis. Neurosurgery 60:S35–S41

    Article  PubMed  Google Scholar 

  15. Nurick S (1972) The pathogenesis of the spinal cord disorder associated with cervical spondylosis. Brain 95:87–100

    Article  CAS  PubMed  Google Scholar 

  16. Fujiwara A, Kobayashi N, Saiki K, Kitagawa T, Tamai K, Saotome K (2003) Association of the Japanese Orthopaedic Association score with the Oswestry Disability Index, Roland–Morris Disability Questionnaire, and short-form 36. Spine (Phila Pa 1976) 28:1601–1607

    Google Scholar 

  17. Revanappa KK, Moorthy RK, Jeyaseelan V, Rajshekhar V (2015) Modification of Nurick scale and Japanese Orthopedic Association score for Indian population with cervical spondylotic myelopathy. Neurol India 63:24–29

    Article  PubMed  Google Scholar 

  18. Vitzthum HE, Dalitz K (2007) Analysis of five specific scores for cervical spondylogenic myelopathy. Eur Spine J 16:2096–2103

    Article  PubMed  PubMed Central  Google Scholar 

  19. Dalitz K, Vitzthum HE (2008) Evaluation of five scoring systems for cervical spondylogenic myelopathy. Spine J. doi:10.1016/j.spinee.2008.05.005

    PubMed  Google Scholar 

  20. Revanappa KK, Rajshekhar V (2011) Comparison of Nurick grading system and modified Japanese Orthopaedic Association scoring system in evaluation of patients with cervical spondylotic myelopathy. Eur Spine J 20:1545–1551

    Article  PubMed  PubMed Central  Google Scholar 

  21. Rhee JM, Heflin JA, Hamasaki T, Freedman B (2009) Prevalence of physical signs in cervical myelopathy: a prospective, controlled study. Spine (Phila Pa 1976) 34:890–895

    Article  Google Scholar 

  22. Wang S, Zhang J, Qiu G, Li S, Yu B, Weng X (2013) Posterior hemivertebra resection with bisegmental fusion for congenital scoliosis: more than 3 year outcomes and analysis of unanticipated surgeries. Eur Spine J 22:387–393

    Article  PubMed  PubMed Central  Google Scholar 

  23. Eck JC, Drew J, Currier BL (2010) Effects of magnetic resonance imaging signal change in myelopathic patients: a meta-analysis. Spine (Phila Pa 1976) 35:E1306–E1309

    Article  Google Scholar 

  24. Barkhof F, McKinstry RC (2005) Quantifying spinal cord demyelination with magnetic transfer imaging. Neurology 64:1677–1678

    Article  PubMed  Google Scholar 

  25. Do-Dai DD, Brooks MK, Goldkamp A, Erbay S, Bhadelia RA (2010) Magnetic resonance imaging of intramedullary spinal cord lesions: a pictorial review. Curr Probl Diagn Radiol 39:160–185

    Article  PubMed  Google Scholar 

  26. Nemani VM, Kim HJ, Bjerke-Kroll BT, Yagi M, Sacramento-Dominguez C, Akoto H et al (2015) Preoperative halo-gravity traction for severe spinal deformities at an SRS-GOP site in West Africa: protocols, complications, and results. Spine (Phila Pa 1976) 40:153–161

    Article  Google Scholar 

  27. Koller H, Zenner J, Gajic V, Meier O, Ferraris L, Hitzl W (2012) The impact of halo-gravity traction on curve rigidity and pulmonary function in the treatment of severe and rigid scoliosis and kyphoscoliosis: a clinical study and narrative review of the literature. Eur Spine J 21:514–529

    Article  PubMed  PubMed Central  Google Scholar 

  28. Cecchinato R, Berjano P, Aguirre MF, Lamartina C (2015) Asymmetrical pedicle subtraction osteotomy in the lumbar spine in combined coronal and sagittal imbalance. Eur Spine J 24(Suppl 1):S66–S71

    Article  PubMed  Google Scholar 

  29. Yang BP, Chen LA, Ondra SL (2008) A novel mathematical model of the sagittal spine: application to pedicle subtraction osteotomy for correction of fixed sagittal deformity. Spine J 8:359–366

    Article  PubMed  Google Scholar 

  30. Cao K, Watanabe K, Kawakami N, Tsuji T, Hosogane N, Yonezawa I et al (2014) Selection of lower instrumented vertebra in treating Lenke type 2A adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 39:E253–E261

    Article  Google Scholar 

  31. Sun Z, Qiu G, Zhao Y, Wang Y, Zhang J, Shen J (2014) Lowest instrumented vertebrae selection for selective posterior fusion of moderate thoracolumbar/lumbar idiopathic scoliosis: lower-end vertebra or lower-end vertebra + 1? Eur Spine J 23:1251–1257

    Article  PubMed  Google Scholar 

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Acknowledgments

This work was supported by the National Natural Science Foundation of China (81272054, 81171673).

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    Authors and Affiliations

    1. Department of Orthopedics, Peking Union Medical College Hospital, No. 1 Shuai Fu Yuan, Wang Fu Jing Street, Beijing, 100730, People’s Republic of China

      Qianyu Zhuang, Jianguo Zhang, Shengru Wang, Jianwei Guo & Guixing Qiu

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    1. Qianyu Zhuang
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    2. Jianguo Zhang
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    3. Shengru Wang
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    4. Jianwei Guo
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    5. Guixing Qiu
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    Correspondence to Jianguo Zhang.

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    The authors declare that they have no conflict of interests related to this work.

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    Qianyu Zhuang and Jianguo Zhang have contributed equally to this paper.

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    Zhuang, Q., Zhang, J., Wang, S. et al. Multiple cervical hemivertebra resection and staged thoracic pedicle subtraction osteotomy in the treatment of complicated congenital scoliosis. Eur Spine J 25 (Suppl 1), 188–193 (2016). https://doi.org/10.1007/s00586-015-4352-9

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    • DOI: https://doi.org/10.1007/s00586-015-4352-9

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