Prospective case series
Results of surgical treatment of complex vertebral transposition “Gamma Deformity” > 180 degrees with halo gravity traction (HGT) and vertebral column resection (VCR).
Summary of background data
We recently published a novel classification system for complex spine deformities of which complex vertebral transposition > 180 degrees (Gamma; type 3) was described. Halo gravity traction (HGT) has been shown to mitigate surgical risk in complex spine deformity correction and in some cases obviates the need for three-column osteotomy. However, we are not aware of report of its utilization in treating Gamma deformities with or without vertebral column resection (VCR).
A consecutive series of 13 patients with Gamma deformity (GD) were prospectively enrolled at a single site in West Africa. Standard radiographs and 3D computerized tomography (CT) were done to assess coronal and sagittal vertebral transposition (CVT and SVT). The HGT with 50% of body weight was applied over several weeks followed by VCR. Demographics, operative data, radiographic parameters, and complications data were collected.
13 pts with GD underwent HGT for an avg of 110 days prior to definitive surgery. Etiologies were Congenital—11 pts and Neurofibromatosis—2 pts. Average age: 17.8 years; Pts were reviewed at 3 months post-op and at minimum 2-year follow-up. Preop myelopathy was present in five patients. Pre-op CVT avg 75% and was corrected in all cases post-op. SVT avg 211 deg and improved with HGT by 36% and corrected to 53 deg (74% correction) post-op. Thoracic kyphosis avg -42 deg and averaged 48 deg post-op. Intra-op spinal cord monitoring (SCM) alerts occurred in 8 pts (61%). Post-operative LEM deficits occurred in 5 pts: 2 fully recovered by 3 months and 2 year follow-up, while the remaining 3 improved but had residual motor deficits at final follow-up. There was one post-operative mortality.
The management of complex vertebral transposition (Gamma deformity) > 180 degrees with HGT prior to VCR is not only effective in some patients, but also associated with high SCM alerts and neurologic injury rates. Myelopathic patients with thoracic deformities are at higher risk of developing permanent neurologic deficits. Surgeons should be aware of this rare and unusual deformity and consider HGT and VCR bearing in mind the technical challenges and high complication rate.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Smith JT, Gollogly S, Dunn HK (2005) Simultaneous anterior-posterior approach through a costotransversectomy for the treatment of congenital kyphosis and acquired kyphoscoliotic deformities. J Bone Joint Surg Am. 87(10):2281–91
Ozturk C, Alanay A, Ganiyusufoglu K, Karadereler S, Ulusoy L, Hamzaoglu A (2012) Short-term X-ray results of posterior vertebral column resection in severe congenital kyphosis, scoliosis and kyphoscoliosis. Spine 37(12):1054–7
Xie J, Wang Y, Zhao Z, Zhang Y, Si Y, Li T, Yang Z, Liu L (2012 Dec 1) Posterior vertebral column resection for correction of rigid spinal deformity curves greater than 100. J Neurosurg Spine 17(6):540–551
Xie J, Wang Y, Zhao Z, Zhang Y, Si Y, Yang Z, Liu L, Lu N (2011) One-stage and posterior approach for correction of moderate to severe scoliosis in adolescents associated with chiari 1 malformation: is a prior suboccipital decompression always necessary? J Eur Spine 20(7):1106–2015
Zhang Z, Wang H, Shangguan L (2013) Posterior 2-level vertebral column resection for the treatment of progressive rotational dislocation in kyphoscoliotic deformities. World Neurosurg. 88:428–32. https://doi.org/10.1016/j.wneu.2015.10.057
Yang C, Zheng Z, Liu H, Wang J, Kim YJ, Cho S (2016) Posterior vertebral column resection in spinal deformity: a systematic review. Eur Spine J 25(8):2368–2375
Lenke LG, Newton PO, Sucato DJ et al (2013) Complications after 147 consecutive vertrbral column resections for severe pediatric spinal deformity. Spine 30:119–132
Auerbach JD, Lenke LG, Bridwell KH et al (2012) Major complications and comparison between 3-column osteotomy techniques in 105 consecutive spinal deformity procedures. Spine 37:1198–1210
Rajasekaran S, Rishi MKP, Shetty AP (2011) Closing-opening wedge osteotomy for severe, rigid, thoracolumbar post-tubervular kyphosis. J Eur Spine 20(3):343–7
Karikari IO, Pang H, Yankey KP, Duah HO, Akoto H, Hodes R, Boachie-Adjei O (2019) FOCOS Spine Research Group A novel radiographic classification of severe spinal curvatures exceeding 100: the Omega (Ω), gamma (γ) and alpha (α) deformities. Eur Spine J 3:1–2
Boachie-Adjei O, Yagi M, Nemani VM, Sacramento-Dominguez C, Akoto H, Cunningham ME, Gupta M, Hess WF, Lonner BS, Mendelow MJ, Papadopoulus EC (2015 Jan 1) Incidence and risk factors for major surgical complications in patients with complex spinal deformity: a report from an SRS GOP site. Spine Deform 3(1):57–64
Nemani VM, Kim HJ, Bjerke-Kroll BT, Yagi M, Sacramento-Dominguez C, Akoto H, Papadopoulos EC, Sanchez-Perez-Grueso F, Pellise F, Nguyen JT, Wulff I (2015 Feb 1) Preoperative halo-gravity traction for severe spinal deformities at an SRS-GOP site in West Africa: protocols, complications, and results. Spine 40(3):153–161
Anthony Rinella, Lawrence Lenke, Camden Whitaker (2005) More Preoperative Halo Gavity Traction in the treatment of severe scoliosis and kyphosis. Spine 30(4):475–482
Iyer S, Boachie-Adjei O, Duah HO, Yankey KP, Mahmud R, Wulff I, Tutu HO, Akoto H (2019 ) Halo gravity traction can mitigate preoperative risk factors and early surgical complications in complex spine deformity. Spine 44(9):629–636
Audigé L, Bhandari M, Hanson B, Kellam J (2005 Jul 1) A concept for the validation of fracture classifications. J Orthop Trauma 19(6):404–409
Garbuz DS, Masri BA, Esdaile J, Duncan CP (2002) Classification systems in orthopaedics. J Am Acad Orthop Surg 10(4):290–7
Demirkiran G, Dede O, Karadeniz E, Olgun D, Ayvaz M, Yazici M (2017) Anterior and posterior vertebral column resection versus posterior-only technique. Clin Spine Surg 30(7):285–290
Lee BH, Hyun SJ, Kim KJ, Jahng TA, Kim YJ, Kim HJ (2018) Clinical and radiological outcomes of posterior vertebral column resection for severe spinal deformities. J Korean Neurosurg Soc 61(2):251
Papadopoulos EC, Boachie-Adjei O, Hess WF, Perez-Grueso FJ, Pellisé F, Gupta M, Lonner B, Paonessa K, Faloon M, Cunningham ME, Kim HJ (2015 ) Early outcomes and complications of posterior vertebral column resection. Spine J 15(5):983–991
Kawahara N, Tomita K, Baba H, Kobayashi T, Fujita T, Murakami H (2001 ) Closing–opening wedge osteotomy to correct angular kyphotic deformity by a single posterior approach. Spine 26(4):391–402
Wang XB, Lenke LG, Thuet E, Blanke K, Koester LA, Roth M (2016 ) Deformity angular ratio describes the severity of spinal deformity and predicts the risk of neurologic deficit in posterior vertebral column resection surgery. Spine 41(18):1447–1455
Wang S, Aikenmu K, Zhang J, Qiu G, Guo J, Zhang Y, Weng X (2017) The aim of this retrospective study is to evaluate the efficacy and safety of posterior-only vertebral column resection (PVCR) for the treatment of angular and isolated congenital kyphosis. Eur Spine J 26(7):1817–1825
The paper was funded with a grant from K2M (Grant No: K2M/FC/060216).
Conflict of interest
Oheneba Boachie-Adjei (grants, personal fees and other from K2M, other from WEIGAO, outside the submitted work). For the remaining authors none were declared.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
IRB approval statement
The study was approved by the institutional review board (IRB) of the Noguchi Memorial Institute for Medical Research (NMIMR), College of Health Sciences, University of Ghana (Study Protocol Number: 045/15–16 revised in 2019).
See Fig. 8.
About this article
Cite this article
Boachie-Adjei, O., Sacramento-Dominguez, C., Ayamga, J. et al. Characterization of complex vertebral transposition (gamma deformity) > 180 degrees: clinical and radiographic outcomes of halo gravity traction and vertebral column resection (VCR). Spine Deform (2020). https://doi.org/10.1007/s43390-020-00179-1
- Vertebral transposition
- Gamma deformity
- Complex spine deformity
- Halo gravity traction
- Vertebral column resection