Posterior Multilevel Vertebral Osteotomy for Severe and Rigid Idiopathic and Nonidiopathic Kyphoscoliosis A Further Experience With Minimum Two-Year Follow-Up

Abstract

Study Design. Prospective randomized study. Objective. To evaluate the clinical and radiologic outcome of posterior multilevel vertebral osteotomy (PMVO) in patients with severe kyphoscoliosis. Summary of Background Data. Authors have developed and reported results of PMVO for correction of neuromuscular scoliosis. PMVO has advantages such as, posterior-only procedure which avoids risk to pulmonary complications and gives satisfactory correction. However, its effect in correcting severe scoliosis in presence of rigid kyphosis has not been reported. Methods. Thirteen patients (7 idiopathic, 4 cerebral palsy, and 2 congenital scoliosis) with severe and rigid kyphoscoliosis were operated by posterior-only correction with pedicle screw fixation using PMVO. As per pathology, and associated severity of kyphosis little modification in the original technique was applied while correction and osteotomy. Neuromonitoring was applied in all patients during operation. The radiologic and clinical results were evaluated with an average follow-up of 42.9 +/- 11 months. All postoperative complications were also noted during the follow-up period. Results. Average number of osteotomy was 4.2 +/- 0.8 (range, 3-5). Average preoperative Cobb angle, pelvic obliquity, thoracic kyphosis, and lumbar lordosis were 99.2 degrees +/- 29.6 degrees, 8.6 degrees +/- 9 degrees, 73.6 degrees +/- 56.9 degrees, and -47.2 degrees +/- 63.2 degrees, respectively, which improved after surgery to 44.7 degrees +/- 12.3 degrees, 2.8 degrees +/- 2.9 degrees, 45.3 degrees +/- 15.9 degrees, and -47.7 degrees +/- 12.2 degrees. All corrections were maintained at final follow-up. A 54.3% correction was achieved in coronal plane; and, full correction was achieved in sagital plane as thoracic kyphosis was restored within normal range. Average blood loss and operative time was 3015 + 1213 mL and 6.01 +/- 1.09 hours, respectively. Three patients had postoperative respiratory complications; 2 had hemothorax and 1 had atelectasis; none had follow-up consequences. All pulmonary complications were due to associated thoracoplasty during which pleura was ruptured intraoperatively. Two patients had complication related with the implants; 1 screw breakage and other screw prominence. There was no neurologic injury intraoperatively on motor-evoked po-tentials (MEP) or clinically after surgery. Conclusion. PMVO exhibited satisfactory clinical and radiologic results in patients with severe and rigid scoliosis associated with hyperkyphosis at minimum 2-year follow-up. It can be safely applied with modifications in original technique for complex congenital scoliosis with multilevel hemi or block vertebrae and idiopathic/nonidiopathic spinal deformities.