Study Design: 

Retrospective case series.

Objective: 

To evaluate the safety and efficacy of spine-shortening using 1-stage 3-column osteotomy for a severe rigid spinal deformity with a spinal cord malformation (SCM).

Summary of Background Data: 

One-stage spine-shortening osteotomy has been suggested for the treatment of a tethered spinal cord. However, the safety and efficacy of 1-stage spine-shortening osteotomy for the treatment of a severe spinal deformity with an SCM is not known.

Methods: 

The records of 32 patients with a severe spinal deformity and SCM treated with spine-shortening using 3-column osteotomy from January 2010 to December 2016 were analyzed retrospectively. Intraoperative neurophysiological monitoring was used in all cases. Imaging parameters and neurological complications were analyzed to evaluate clinical safety and efficacy.

Results: 

Spine-shortening using a 3-column osteotomy was conducted successfully in all 32 patients. The mean main coronal curve and maximum kyphotic angle were corrected from 119.8 and 119.1 degrees to 58.6 and 53.9 degrees, respectively, with the corrective rate of 51.4% and 54.3%. The mean correction loss of the major coronal curve and maximum kyphosis was 2.3 and 2.6 degrees, respectively, at a mean follow-up of 73.6 months. Intraoperative monitoring events occurred in 9 patients; of these 9 patients, 3 suffered transient SC injury, and all recovered within 1 year without suffering permanent paralysis.

Conclusions: 

Spine-shortening using a 3-column osteotomy seems to be safe and efficacious for treating a severe spinal deformity with an SCM. A deep understanding of the method and intensive intraoperative neuromonitoring improved the safety of this challenging and complex surgical procedure.

中文翻译：

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一期脊柱缩短截骨术治疗与脊髓畸形相关的严重脊柱畸形

学习规划： 

回顾性案例系列。

客观的： 

旨在评估使用 1 阶段3 柱截骨术进行脊柱缩短术治疗伴有脊髓畸形 (SCM) 的严重僵硬脊柱畸形的安全性和有效性。

背景数据摘要： 

建议采用一期脊柱缩短截骨术来治疗脊髓栓系。然而，一阶段脊柱缩短截骨术通过 SCM治疗严重脊柱畸形的安全性和有效性尚不清楚。

方法： 

回顾性分析2010年1月至2016年12月期间采用三柱截骨缩短脊柱治疗的32例严重脊柱畸形合并SCM患者的临床资料。所有病例均采用术中神经生理学监测。分析影像参数和神经并发症，以评估临床安全性和有效性。

结果： 

使用3 柱截骨术对所有 32 名患者进行了脊柱缩短术。平均主冠状曲线和最大后凸角分别由119.8度和119.1度矫正至58.6度和53.9度，矫正率分别为51.4%和54.3%。在平均随访 73.6 个月时，主冠状曲线和最大后凸畸形的平均矫正损失分别为 2.3 度和 2.6 度。9例患者发生术中监测事件；这9名患者中，3名出现短暂性SC损伤，全部在1年内康复，没有出现永久性瘫痪。

结论： 

使用3 柱截骨术进行脊柱缩短对于使用 SCM治疗严重脊柱畸形似乎是安全有效的。对该方法的深入理解和强化术中神经监测提高了这种具有挑战性和复杂的外科手术的安全性。