EFFECTIVENESS COMPARISON BETWEEN PEDICLE SUBTRACTION OSTEOTOMY AND NON-OSTEOTOMYTECHNIQUES IN TREATMENT OF MEDIUM-TO-SEVERE KYPHOSCOLIOSIS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHOU Jianwei , PENG Jinsheng , YANG Bin , NIU Jing , CHEN Zhiming , WANG Xiaoping , LI Jia , MA Huasong.

Spine Centre of Chinese PLA, the 306th Hospital of Chinese PLA, Beijing, 100101, P.R.China;

Corresponding author：

Keywords：

Kyphoscoliosis; Pedicle subtraction osteotomy; Thoracolumbar spine

Video：

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Objective To evaluate the effectiveness of pedicle subtraction osteotomy (PSO) and non-osteotomy techniques in treatment of medium-to-severe kyphoscoliosis by retrospective studies. Methods Between January 2005 and January 2009, 99 patients with medium-to-severe kyphoscoliosis were treated by PSO (PSO group, n=46) and non-osteotomy
technique (non-osteotomy group, n=53) separately. There was no significant difference in sex, age, Cobb angle of scol iosis on coronal plane, and Cobb angle of kyphosis on saggital plane between 2 groups (P gt; 0.05). The operation time and blood loss were recorded; the Cobb angle of scol iosis on coronal plane and kyphosis on sagittal plane were measured at pre- and postoperation to caculate the rates of correction on both planes. Results The operation was successfully completed in all the patients. The operation time and blood loss of the patients in PSO group were significantly greater than those of the patients in non-osteotomy group (P lt; 0.05). All patients were followed up 12-56 months (mean, 22.4 months); no spinal cord injury occurred, and bone fusion was achieved at last follow-up. The Cobb angles of scol iosis and kyphosis at 2 weeks and last follow-up were significantly improved when compared with the preoperative angles in the patients of 2 groups (P lt; 0.05). There was no significant difference in Cobb angle of scol iosis and the rate of correction between 2 groups (P gt; 0.05), but the correction loss of PSO group was significantly smaller than that of non-osteotomy group (P lt; 0.05) at last follow-up. At 2 weeks and last follow-up, the Cobb angle of kyphosis, the rate of correction, and correction loss were significantly better in PSO group than in non-osteotomy group (P lt; 0.05). Conclusion There is no signifcant difference in scol iosis correction between PSO and non-osteotomy techniques.PSO can get better corrective effect in kyphosis correction than non-osteotomy technique, but the operation time and blood loss
would increase greatly.

Citation： ZHOU Jianwei,PENG Jinsheng,YANG Bin,NIU Jing,CHEN Zhiming,WANG Xiaoping,LI Jia,MA Huasong.. EFFECTIVENESS COMPARISON BETWEEN PEDICLE SUBTRACTION OSTEOTOMY AND NON-OSTEOTOMYTECHNIQUES IN TREATMENT OF MEDIUM-TO-SEVERE KYPHOSCOLIOSIS. Chinese Journal of Reparative and Reconstructive Surgery, 2012, 26(4): 406-410. doi: Copy

1.	Heining CF. Eggshell procedure//Luque ER, eds. Segmental Spinal Instrumentation. Thorofare, New Jersey: Slack, 1984: 221-234.
2.	Thomasen E. Vertebral osteotomy for correction of kyphosis in ankylosing spondylitis. Clin Orthop Relat Res, 1985, (194): 142-152.
3.	Halm H. Pedicle subtraction osteotomy for correction of congenital scoliokyphosis. Eur Spine J, 2011, 20(6): 995-996.
4.	Bakaloudis G, Lolli F, Di Silvestre M, et al. Thoracic pedicle subtraction osteotomy in the treatment of severe pediatric deformities. Eur Spine J, 2011, 20 Suppl 1: S95-104.
5.	Quraishi NA, Lewis SJ, Kelleher MO, et al. Intraoperative multimodality monitoring in adult spinal deformity: analysis of a prospective series of one hundred two cases with independent evaluation. Spine (Phila Pa 1976), 2009, 34(14): 1504-1512.
6.	Bridwell KH, Lewis SJ, Rinella A, et al. Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance. Surgical technique. J Bone Joint Surg (Am), 2004, 86-A Suppl 1: 44-50.
7.	刘涛, 马华松, 周建伟, 等. 经椎弓根截骨凸侧悬臂梁技术治疗重度僵硬性先天性脊柱侧后凸. 中国骨肿瘤骨病杂志, 2011, 10(5): 355-359.
8.	陈志明, 马华松, 谭荣, 等. 重度僵硬后凸型脊柱侧凸畸形的手术治疗. 中国骨与关节外科, 2011, 4(1): 27-31.
9.	马华松, 周建伟, 邹德威, 等. 重度僵硬型脊柱侧凸的后路非全椎体截骨手术治疗. 中国矫形外科杂志, 2010, 18(16): 1323-1326.
10.	张宏其, 鲁世金, 陈静, 等. 广泛后路松解三维矫形治疗重度特发性脊柱侧凸. 中国脊柱脊髓杂志, 2007, 17(4): 274-279.
11.	Burton DC, Sama AA, Asher MA, et al. The treatment of large (>70 degrees) thoracic idiopathic scoliosis curves with posterior instrumentation and arthrodesis: when is anterior release indicated? Spine (Phila Pa 1976), 2005, 30(17): 1979-1984.
12.	Cho KJ, Bridwell KH, Lenke LG, et al. Comparison of Smith-Petersen versus pedicle subtraction osteotomy for the correction of fixed sagittal imbalance. Spine (Phila Pa 1976), 2005, 30(18): 2030-2038.
13.	Kim KT, Park KJ, Lee JH. Osteotomy of the spine to correct the spinal deformity. Asian Spine J, 2009, 3(2): 113-123.
14.	Bridwell KH. Decision making regarding Smith-Petersen vs. pedicle subtraction osteotomy vs. vertebral column resection for spinal deformity. Spine (Phila Pa 1976), 2006, 31(19 Suppl): S171-178.
15.	Hyun SJ, Rhim SC. Clinical outcomes and complications after pedicle subtraction osteotomy for fixed sagittal imbalance patients: a long-term follow-up data. J Korean Neurosurg Soc, 2010, 47(2): 95-101.
16.	Heary RF, Albert TJ. 脊柱畸形精要. 李明, 王岩, 陈仲强, 等译. 上海: 上海科学技术出版社, 2009: 67-68.
17.	邹德威, 谭荣. 三柱截骨治疗重度僵硬性脊柱侧凸的手术决策和风险规避. 中华外科杂志, 2010, 48(11): 1691-1693.
18.	Bakaloudis G, Lolli F, Di Silvestre M, et al. Thoracic pedicle subtraction osteotomy in the treatment of severe pediatric deformities. Eur Spine J, 2011, 20 Suppl 1: S95-104.
19.	Baldus CR, Bridwell KH, Lenke LG, et al. Can we safely reduce blood loss during lumbar pedicle subtraction osteotomy procedures using tranexamic acid or aprotinin? A comparative study with controls. Spine (Phila Pa 1976), 2010, 35(2): 235-239.
20.	Suk SI, Chung ER, Kim JH, et al. Posterior vertebral column resection for severe rigid scoliosis. Spine (Phila Pa 1976), 2005, 30(14): 1682-1687.
21.	Zhu Z, Wang X, Qian B, et al. Loss of correction in the treatment of thoracolumbar kyphosis secondary to ankylosing spondylitis: a comparison between smith-petersen osteotomies and pedicle subtraction osteotomy. J Spinal Disord Tech, 2011. [Epub ahead of print].

1. Heining CF. Eggshell procedure//Luque ER, eds. Segmental Spinal Instrumentation. Thorofare, New Jersey: Slack, 1984: 221-234.
2. Thomasen E. Vertebral osteotomy for correction of kyphosis in ankylosing spondylitis. Clin Orthop Relat Res, 1985, (194): 142-152.
3. Halm H. Pedicle subtraction osteotomy for correction of congenital scoliokyphosis. Eur Spine J, 2011, 20(6): 995-996.
4. Bakaloudis G, Lolli F, Di Silvestre M, et al. Thoracic pedicle subtraction osteotomy in the treatment of severe pediatric deformities. Eur Spine J, 2011, 20 Suppl 1: S95-104.
5. Quraishi NA, Lewis SJ, Kelleher MO, et al. Intraoperative multimodality monitoring in adult spinal deformity: analysis of a prospective series of one hundred two cases with independent evaluation. Spine (Phila Pa 1976), 2009, 34(14): 1504-1512.
6. Bridwell KH, Lewis SJ, Rinella A, et al. Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance. Surgical technique. J Bone Joint Surg (Am), 2004, 86-A Suppl 1: 44-50.
7. 刘涛, 马华松, 周建伟, 等. 经椎弓根截骨凸侧悬臂梁技术治疗重度僵硬性先天性脊柱侧后凸. 中国骨肿瘤骨病杂志, 2011, 10(5): 355-359.
8. 陈志明, 马华松, 谭荣, 等. 重度僵硬后凸型脊柱侧凸畸形的手术治疗. 中国骨与关节外科, 2011, 4(1): 27-31.
9. 马华松, 周建伟, 邹德威, 等. 重度僵硬型脊柱侧凸的后路非全椎体截骨手术治疗. 中国矫形外科杂志, 2010, 18(16): 1323-1326.
10. 张宏其, 鲁世金, 陈静, 等. 广泛后路松解三维矫形治疗重度特发性脊柱侧凸. 中国脊柱脊髓杂志, 2007, 17(4): 274-279.
11. Burton DC, Sama AA, Asher MA, et al. The treatment of large (>70 degrees) thoracic idiopathic scoliosis curves with posterior instrumentation and arthrodesis: when is anterior release indicated? Spine (Phila Pa 1976), 2005, 30(17): 1979-1984.
12. Cho KJ, Bridwell KH, Lenke LG, et al. Comparison of Smith-Petersen versus pedicle subtraction osteotomy for the correction of fixed sagittal imbalance. Spine (Phila Pa 1976), 2005, 30(18): 2030-2038.
13. Kim KT, Park KJ, Lee JH. Osteotomy of the spine to correct the spinal deformity. Asian Spine J, 2009, 3(2): 113-123.
14. Bridwell KH. Decision making regarding Smith-Petersen vs. pedicle subtraction osteotomy vs. vertebral column resection for spinal deformity. Spine (Phila Pa 1976), 2006, 31(19 Suppl): S171-178.
15. Hyun SJ, Rhim SC. Clinical outcomes and complications after pedicle subtraction osteotomy for fixed sagittal imbalance patients: a long-term follow-up data. J Korean Neurosurg Soc, 2010, 47(2): 95-101.
16. Heary RF, Albert TJ. 脊柱畸形精要. 李明, 王岩, 陈仲强, 等译. 上海: 上海科学技术出版社, 2009: 67-68.
17. 邹德威, 谭荣. 三柱截骨治疗重度僵硬性脊柱侧凸的手术决策和风险规避. 中华外科杂志, 2010, 48(11): 1691-1693.
18. Bakaloudis G, Lolli F, Di Silvestre M, et al. Thoracic pedicle subtraction osteotomy in the treatment of severe pediatric deformities. Eur Spine J, 2011, 20 Suppl 1: S95-104.
19. Baldus CR, Bridwell KH, Lenke LG, et al. Can we safely reduce blood loss during lumbar pedicle subtraction osteotomy procedures using tranexamic acid or aprotinin? A comparative study with controls. Spine (Phila Pa 1976), 2010, 35(2): 235-239.
20. Suk SI, Chung ER, Kim JH, et al. Posterior vertebral column resection for severe rigid scoliosis. Spine (Phila Pa 1976), 2005, 30(14): 1682-1687.
21. Zhu Z, Wang X, Qian B, et al. Loss of correction in the treatment of thoracolumbar kyphosis secondary to ankylosing spondylitis: a comparison between smith-petersen osteotomies and pedicle subtraction osteotomy. J Spinal Disord Tech, 2011. [Epub ahead of print].

Chinese Journal of Reparative and Reconstructive Surgery

EFFECTIVENESS COMPARISON BETWEEN PEDICLE SUBTRACTION OSTEOTOMY AND NON-OSTEOTOMYTECHNIQUES IN TREATMENT OF MEDIUM-TO-SEVERE KYPHOSCOLIOSIS

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