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Transpedicular Wedge Resection Osteotomy of the Apical Vertebrae for the Treatment of Severe and Rigid Thoracic Kyphoscoliosis: A Retrospective Study of 26 Cases

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Abstract

Study Design

Retrospective analysis of clinical records.

Objective

To determine the efficacy of transpedicular wedge resection osteotomy (TWRO) of the apical vertebrae to treat severe and rigid thoracic kyphoscoliosis in 26 adults.

Summary of Background Data

Although posterior vertebral column resection has traditionally been used to correct severe and rigid kyphoscoliosis, TWRO may achieve the same correction with a shorter operative time and lower rate of complications.

Methods

Between May 2011 and December 2014, 29 adults underwent a TWRO of the apical vertebrae for severe and rigid thoracic kyphoscoliosis, and 26 adults completed the 24-month follow-up. Radiologic measurements, including coronal plane major curve, kyphotic curve, coronal offset, and sagittal offset, were measured and compared. The following patient-reported health-related quality of life outcomes, including Oswestry Disability Index score, visual analog scale score for back pain, and SRS-22 questionnaire, were used to evaluate the clinical outcomes.

Results

For the 26 patients followed over 24 months, the mean coronal plane major curve improved from 107.6° to 37.5° immediately after surgery and to 40.0° at 24 months postoperatively. The mean kyphotic curve improved from 90.6° to 30.5° immediately after surgery and to 33.3° at 24 months postoperatively. The mean coronal offset and sagittal offset were also improved. Improved self-reported quality of life scores were achieved postoperatively and at 24 months postoperatively, including all domains of the SRS-22 questionnaire. Bony fusion was achieved at 6 or 12 months in all patients. Unilateral leg paresis occurred in one case and recovered after three months, with a neurologic complication rate of 3.8%.

Conclusions

TWRO of the apical vertebrae as a treatment for severe and rigid thoracic kyphoscoliosis in adult patients provided excellent clinical outcomes. However, the procedure remains technically demanding and exhausting, with a potential risk for complications.

Level of Evidence

Level IV.

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Authors and Affiliations

  1. Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China

    Wenbin Hua MD, Yukun Zhang MD, Xinghuo Wu MD, Yong Gao MD, Shuai Li MD, Kun Wang MD, Shuhua Yang MD & Cao Yang MD

Authors
  1. Wenbin Hua MD
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  2. Yukun Zhang MD
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  3. Xinghuo Wu MD
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  4. Yong Gao MD
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  5. Shuai Li MD
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  6. Kun Wang MD
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  7. Shuhua Yang MD
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  8. Cao Yang MD
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Corresponding author

Correspondence to Cao Yang MD.

Additional information

Author disclosures: WH (none), YZ (none), XW (none), YG (none), SL (none), KW (none), SY (none), CY (none).

Funding: This work was supported by the National Key Research and Development Program of China (2018YFB1105700) and the National Natural Science Foundation of China (grant nos. 81772401 and U1603121).

Ethics Statement: This study was conducted in accordance with the Declaration of Helsinki and with approval from the Ethics Committee of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology.

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Hua, W., Zhang, Y., Wu, X. et al. Transpedicular Wedge Resection Osteotomy of the Apical Vertebrae for the Treatment of Severe and Rigid Thoracic Kyphoscoliosis: A Retrospective Study of 26 Cases. Spine Deform 7, 338–345 (2019). https://doi.org/10.1016/j.jspd.2018.08.001

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  • DOI: https://doi.org/10.1016/j.jspd.2018.08.001

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