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| ZHANG Yangpu,HAI Yong,TAO Luming.Radiographic analysis of multilevel asymmetric Ponte osteotomy vs vertebral column resection in severe rigid adult idiopathic kyphoscoliosis[J].Chinese Journal of Spine and Spinal Cord,2019,(6):498-504. |
| Radiographic analysis of multilevel asymmetric Ponte osteotomy vs vertebral column resection in severe rigid adult idiopathic kyphoscoliosis |
| Received:March 31, 2019 Revised:May 14, 2019 |
| English Keywords:Idiopathic kyphoscoliosis Spinal osteotomy Ponte osteotomy Vertebral column resection Posterior spinal internal fixation |
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| 【Abstract】 Objectives: To compare the coronal and sagittal radiographic difference of MAPO and VCR in severe rigid adult idiopathic kyphoscoliosis(AIKS). Methods: A retrospective study was conducted for patients with severe rigid AIKS who underwent posterior MAPO or VCR surgery in our hospital from May 2009 to March 2016. All the patients had at least 2 years follow-up. Clinical and radiographic data(full spine X-ray, full spine bending X-ray) before operation, immediately after operation, and at final follow-up were collected. All patients were divided into MAPO group and VCR group according to the osteotomy method. Statistical analysis was used to compare the differences in radiographic parameters including Cobb angle of main curve and focal kyphosis, apical vertebral translation, coronal and sagittal balance, thoracic kyphosis, and lumbar lordosis. Subgroup analysis was performed on patients with pre-existing coronal and sagittal imbalance to assess the improvement of coronal and sagittal balance. Results: A total of 30 cases with AIKS was analyzed. There were 7 males and 23 females with an average age of 26.97±8.88 years. The average follow-up time was 28.70±7.05 months. The main curves were corrected from the average of 103.21°±16.97° and 110.79°±15.97° to 48.58°±17.27° and 57.33°±17.43° respectively. The main curve correction rate was (53.13±13.71)% and (48.89±12.81)% respectively. The local kyphosis was corrected from 85.21°±26.80° and 93.3° ±25.09° to 39.66°±20.28° and 56.90°±21.36°, and the local kyphosis correction rate was (47.20±19.92)% and (38.38±12.89)%, respectively. Coronal and sagittal radiographic parameters including coronal and sagittal balance, thoracic kyphosis, and lumbar lordosis all improved in two groups, and the difference between the two groups was not statistically significant. The subgroup analysisshowed that, except for the increase of sagittal balance in VCR group, the other parameters were improved to some extent, but there was no statistical difference before and after surgery and the same between the two groups. The mean surgical time and blood loss in VCR group were significantly higher than those in MAPO group. The incidence of complication in MAPO group was significantly lower than that in VCR group. Conclusions: Multilevel asymmetric Ponte osteotomy for severe and rigid AIKS can achieve similar coronal and sagittal radiographic improvements with VCR and significantly reduce operative time and postoperative complications. |
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