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| ZHONG Woquan,JIANG Liang,SUN Yu.Single anterior via combined anterior-posterior correction for severe cervical spine kyphosis[J].Chinese Journal of Spine and Spinal Cord,2012,(3):235-240. |
| Single anterior via combined anterior-posterior correction for severe cervical spine kyphosis |
| Received:October 08, 2011 Revised:December 15, 2011 |
| English Keywords:Cervical kyphosis Severe Corrective surgery Anterior approach Combined anterior-posterior approach Outcome |
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| English Abstract: |
| 【Abstract】 Objectives： To evaluate the indications and surgical outcome of single anterior and combined anterior-posterior correction for severe cervical spine kyphosis. Methods: Twelve patients(8 males and 4 females ) with severe cervical spine kyphosis(Cobb angle >40°) treated surgically in our hospital from July 2005 to December 2008 were analyzed retrospectively. The average age was 28.75 years(range: 13-69 years). According to the etiology, 4 patients had congenital deformity, 3 had neurofibromatosis, 2 had degenerative kyphosis, 2 had posttraumatic deformity and 1 had C2-C5 post-laminectomy cervical kyphosis due to meningioma. The average preoperative JOA score was 11.6(range: 7-16). The average preoperative Cobb angle was 69.7°(range: 41°-113°). All the patients underwent corrective surgery: single anterior approach for 8 patients（the preoperative Cobb angle was 58.9°, range: 41°-86°; average JOA score was 11.9 without posterior bony union in the kyphotic segment） and combined anterior-posterior for 4 patients(3 cases with Cobb angle >90°,1 case with circumferential bony union, the preoperative Cobb angle was 91.3°, range: 48°-113°, average JOA score was 11.0). Of the 4 cases undergoing combined surgery, 1 had one-stage and 3 had two-stage surgery. The operation time, blood loss, post-operative Cobb angle, JOA score and Cobb angle at follow-up were collected and compared. Results: For single anterior approach group, the average operation time was 196min and blood loss was 520ml. Two cases suffered from limb weakness after operation; one of them experienced revision surgery due to instrument failure 5 days after operation, while the other one experienced methylprednisolone(MP) intervention. Both of them had symptom relieved completely. The average post-operative Cobb angle was 24.1° with the correction ratio of 59.1%, and the average Cobb angle at final follow-up(27.3 months in average, range: 8-60 months) was 36.9°, with the loss of correction of 36.8%. The JOA score at final follow-up was 15.1(range: 11-17), with the improving ratio of 62.7%. While for the combined anterior-posterior surgery group, the average operation time was 420min and blood loss was 1088ml. One case suffered from limb weakness after operation, who experienced MP intervention and had symptom relieved completely except the weakness in deltoids and biceps. The average post-operative Cobb angle was 32° with the correction ratio of 65.0%. The average Cobb angle at final follow-up(24.8 months in average, range: 6-45 months) was 45.5° with the loss of correction of 22.8%. The JOA score at final follow-up was 13.5(range: 9-16), with the improving ratio of 41.7%. Conclusions: For severe cervical spine kyphosis, single anterior correction is indicated for cases with Cobb angle of 40°-90° and without posterior bony union; while for cases with Cobb angle >90° or having circumferential bony union, combined anterior-posterior correction is indicated. The short-term outcome of both strategies was fairly. |
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