STUDY DESIGN: Outcomes of transpedicular decompression and/or osteotomy were analyzed retrospectively. OBJECTIVES: To determine the effectiveness of decompression and correction, fusion stability, procedural safety, neurologic outcome, complication rates, and overall patient outcomes. SUMMARY OF BACKGROUND INFORMATION: The "eggshell" procedure is reserved for complex reconstructive problems in the treatment of acute trauma, deformity, tumor, or infection. The technique encompasses a range of procedures from simple transpedicular decompression and posterior fusion to more complex procedures, including transpedicular vertebrectomy and strut-grafting or pedicle subtraction (closing wedge) osteotomy with posterolateral fusion. These procedures are completed through a single posterior midline incision, with anterior spinal canal decompression a transpedicular approach, accompanied by a posterior or posterolateral fusion and internal fixation. METHODS: From 1990 to 1998, 59 "eggshell" procedures were performed for 37 deformity cases and 22 tumor or infection cases. Forty-two patients had a minimum 2-year follow-up, averaging 4.5 +/- 2.5 years. Thirty-six patients were available for patient interview, physical examination, and radiographic analysis. Outcome data were collected using SF-36 and SRS instruments. RESULTS: No patients worsened neurologically, and all incomplete spinal cord injuries improved. All patients achieved solid fusion radiographically. Correction with osteotomy averaged 26 degrees. Systemic complication rates were low with a pulmonary complication rate of 5%. Blood loss averaged 2342 mL. Overall patient outcomes were below population norms, but patient satisfaction was very high. CONCLUSION: Overall, the results suggest that the "eggshell" procedure is a reliable and safe technique to achieve anterior decompression of the spinal canal and posterior stabilization through a single approach.
STUDY DESIGN: Outcomes of transpedicular decompression and/or osteotomy were analyzed retrospectively. OBJECTIVES: To determine the effectiveness of decompression and correction, fusion stability, procedural safety, neurologic outcome, complication rates, and overall patient outcomes. SUMMARY OF BACKGROUND INFORMATION: The "eggshell" procedure is reserved for complex reconstructive problems in the treatment of acute trauma, deformity, tumor, or infection. The technique encompasses a range of procedures from simple transpedicular decompression and posterior fusion to more complex procedures, including transpedicular vertebrectomy and strut-grafting or pedicle subtraction (closing wedge) osteotomy with posterolateral fusion. These procedures are completed through a single posterior midline incision, with anterior spinal canal decompression a transpedicular approach, accompanied by a posterior or posterolateral fusion and internal fixation. METHODS: From 1990 to 1998, 59 "eggshell" procedures were performed for 37 deformity cases and 22 tumor or infection cases. Forty-two patients had a minimum 2-year follow-up, averaging 4.5 +/- 2.5 years. Thirty-six patients were available for patient interview, physical examination, and radiographic analysis. Outcome data were collected using SF-36 and SRS instruments. RESULTS: No patients worsened neurologically, and all incomplete spinal cord injuries improved. All patients achieved solid fusion radiographically. Correction with osteotomy averaged 26 degrees. Systemic complication rates were low with a pulmonary complication rate of 5%. Blood loss averaged 2342 mL. Overall patient outcomes were below population norms, but patient satisfaction was very high. CONCLUSION: Overall, the results suggest that the "eggshell" procedure is a reliable and safe technique to achieve anterior decompression of the spinal canal and posterior stabilization through a single approach.
Authors: Joseph S Butler; John P Burke; Roisin T Dolan; Philip Fitzpatrick; John M O'Byrne; Damian McCormack; Keith Synnott; Ashley R Poynton Journal: Eur Spine J Date: 2010-06-27 Impact factor: 3.134