Abstract
Purpose
Severe kyphoscoliosis produces combined coronal and sagittal imbalance, a challenging presentation of Adult Spinal Deformity (ASD). Vertebral column resection (VCR) provides three-dimensional correction typically reserved for severe and/or fixed deformities. The challenge of a VCR is to stabilize the spinal column during incremental reduction maneuvers to correct the deformity. We describe novel use of sub-laminar bands with a temporary pivoting rod construct to achieve coronal and sagittal correction in one reductive maneuver.
Methods
All available notes, imaging, and reports were summarized for inclusion.
Results
A 67-year-old male presented severe, progressive thoracolumbar kyphoscoliosis, subsequent back pain, and difficulty in ambulating. Given the progression, surgical intervention was undertaken. The patient underwent an L3 VCR followed by instrumentation from T2 to pelvis. Kyphoscoliosis correction was performed via a single reduction maneuver using novel pivoting-rod construct and sub-laminar bands followed by quad-rod construct placement. Fresh, frozen, femoral head allograft, and BMP were utilized. The patient was placed in a Jewett brace for 6 weeks postoperatively and recovered. His condition remains optimized at three-year follow-up.
Conclusion
Correcting three-dimensional deformities can require vertebral column resection and pose risk during correction. We propose a sub-laminar band with a pivot-rod construct as a safe, effective technique, limiting the number of reduction maneuvers.
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Abbreviations
- ASD:
-
Adult spinal deformity
- PVCR:
-
Posterior vertebral column resection
- PTSB:
-
Polyethylene terephthalate sub-laminar band
References
Smith JS et al (2008) Vertebral column resection for rigid spinal deformity. Neurosurgery. https://doi.org/10.1227/01.NEU.0000320429.32113.85. (PMID: 18812922)
Saifi C, Laratta JL, Petridis P, Shillingford JN, Lehman RA, Lenke LG (2017) Vertebral column resection for rigid spinal deformity. Global Spine J 7(3):280–290
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
Lyer S, Nemani VM, Kim HJ (2016) A review of complications and outcomes following vertebral column resection in adults. Asian Spine J 10(3):601–609
Keith H. Bridwell MD, Munish Gupta MD (2020) Posterior spinal deformity correction techniques. In: Bridwell K, DeWald R (eds) The textbook of spinal surgery, vol 2, 4th edn. Wolters Kluwer, Lippincott Williams & Wilkins, Philadelphia, pp 824–847 https://oce.ovid.com/book/ovid. Accessed 06 Aug 2021
Senkoylu A, Cetinkaya M (2017) Correction maneuvers in the surgical treatment of spinal deformities. EFORT Open Rev 2(5):135–140
Ailon T, Smith JS, Shaffrey CI et al (2015) Degenerative spinal deformity. Neurosurgery 77(Suppl 4):S75-91
Masahiko T, Manabu I, Kuniyoshi A et al (2007) Comparison of novel ultra-high molecular weight polyethylene tape versus conventional metal wire for sublaminar segmental fixation in the treatment of adolescent idiopathic scoliosis. J Spinal Disord Tech 20(6):449–455
La Rosa G, Giglio G, Oggiano L (2011) Surgical treatment of neurological scoliosis using hybrid construct (lumbar transpedicular screws plus thoracic sublaminar acrylic loops). Eur Spine J 20 Suppl 1(Suppl 1):S90–S94
Roberto G, Andrea F, Marcelo G, Marco T (2009) Universal clamp system in thoracolumbar spinal fixation: technical note. Acta Neurochir (Wien) 151(12):1673–1680
Stergios T, Charalampos C, Panagiotis GK (2014) Hybrid circumferential fixation for degenerative lumbosacral spine disease: posterior lumbar interbody fusion plus universal clamp rod-band instrumentation: a novel technique for lumbosacral fixation. Spine (Phila Pa 1976) 39(7):E441–E449
de Jérôme Sales G, Jean-Luc J, Brice I, Benjamin B, Franck A, Keyvan M (2014) Use of the universal clamp in adolescent idiopathic scoliosis. Eur Spine J 23(Suppl 4):S446–S451
Brice I, Julien E, Yan L et al (2010) Hybrid constructs for tridimensional correction of the thoracic spine in adolescent idiopathic scoliosis: a comparative analysis of universal clamps versus hooks. Spine (Phila Pa 1976) 35(3):306–314
La Rosa G, Giglio G, Oggiano L (2013) The universal clamp hybrid system: a safe technique to correct deformity and restore kyphosis in adolescent idiopathic scoliosis. Eur Spine J 22 Suppl 6(Suppl 6):S823–S828
La Rosa G, Giglio G, Oggiano L (2012) Sagittal profile control in patients affected by neurological scoliosis using universal clamps: a 4-year follow-up study. Eur Spine J 21 Suppl 1(Suppl 1):S32–S36
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Mugge, L., Dang, D., Cobourn, K. et al. Severe kyphoscoliosis correction utilizing sublaminar bands in the setting of a vertebral column resection: a unique technical report. Spine Deform 11, 747–752 (2023). https://doi.org/10.1007/s43390-023-00640-x
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DOI: https://doi.org/10.1007/s43390-023-00640-x