Posterior Spinal Fusion With Multilevel Posterolateral Convex Disc Releases for the Treatment of Severe Thoracolumbar Scoliosis
Autor: | Robert L. Brochin, Baron S. Lonner, Christopher M. Mikhail, Lily Eaker |
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Rok vydání: | 2020 |
Předmět: |
030222 orthopedics
medicine.medical_specialty business.industry Thoracolumbar scoliosis medicine.medical_treatment Posterior column Sagittal plane Vertebra Surgery 03 medical and health sciences 0302 clinical medicine medicine.anatomical_structure Lumbar Coronal plane Spinal fusion medicine Orthopedics and Sports Medicine business Lumbar lordosis Lumbar Spine 030217 neurology & neurosurgery |
Zdroj: | Int J Spine Surg |
ISSN: | 2211-4599 |
DOI: | 10.14444/7041 |
Popis: | Background: Severe, rigid thoracolumbar scoliosis presents a surgical challenge to achieve 3-dimensional correction, maximize distal motion segments, and avoid operative morbidity conferred by combined anterior-posterior approaches or 3-column osteotomies. We present a new approach for releasing these curves, using multilevel posterolateral convex disc release (PCDR) and posterior instrumented fusion. Methods: There were 3 adults and 1 adolescent (mean age, 31.8 years; 2 females) with severe progressive thoracic and transforaminal lumbar (major) idiopathic scoliosis (IS) who were treated with 3-level PCDR, multiple posterior column osteotomies, and posterior instrumented thoracolumbar fusion with all–pedicle screw constructs. Results: Restoration of global coronal and sagittal alignment was achieved for all patients (minimum 2-year follow-up). Lowest instrumented vertebra (LIV) was L4 in 2 patients and L3 in the remaining 2. All except 1 were fused to the lower end vertebra. Postoperatively, mean thoracolumbar curve was reduced from 77.3° (range, 69°–91°) to 21.8° (72%Δ), LIV tilt decreased from 26.8° to 8.3°, and LIV translation improved (2.5–1.2 cm; 58%Δ), whereas lumbar lordosis remained unchanged. Average central sacral vertical line shift measured via C7 sagittal vertical axis changed from 1.4 to −0.7 cm. There were no complications except for dysesthesias in the lower extremity on the side of the PCDR in 1 patient, which resolved after 3 months. Conclusions: Severe thoracolumbar IS presents a surgical challenge to achieve 3-dimensional correction, minimize fusion levels, and avoid procedural morbidity. PCDR is a novel technique that may facilitate this correction with minimal procedure-related morbidity. |
Databáze: | OpenAIRE |
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