D S Bradford1, C B Tribus. 1. Department of Orthopaedic Surgery, University of California, San Francisco, USA.
Abstract
STUDY DESIGN: A retrospective study of patients with rigid coronal decompensation. OBJECTIVES: To determine if patients with rigid coronal decompensation can be safely and successfully treated by anterior-posterior vertebral column resection, spinal shortening, posterior instrumentation, and fusion to correct their deformities. SUMMARY OF BACKGROUND DATA: Previous investigators have described reconstructive techniques used to treat patients with sagittal and coronal spine deformities. These techniques include osteotomy and anterior or posterior fusion. Although a number of these studies consider the problems associated with failed back syndrome (flatback, coronal and axial imbalance, pseudarthrosis), they have not satisfactorily addressed the management of rigid coronal decompensation. The patient population of the current study, on average, presented with more severe, fixed deformities than those detailed in the literature, and required more extensive surgery than previously described. METHODS: Twenty-four patients (average age, 27 years) with rigid coronal decompensation underwent anterior-posterior vertebral column resection, spinal shortening, posterior instrumentation, and fusion. Degree of curvature was measured in the coronal and sagittal planes, and decompensation was assessed. Follow-up was from 2 to 10 years. RESULTS: Coronal and sagittal decompensation were corrected an average of 82% and 87%, respectively; T1 tilt and pelvic obliquity were improved by 65% and 53%, respectively; and scoliosis was improved by 52%. Complications occurred in 14 patients, but at follow-up all patients rated their results as either good or excellent. CONCLUSIONS: Patients with fixed, decompensated spinal deformity may be safely corrected by vertebrectomy, decancellation, spinal shortening, instrumentation, and fusion. Complications are transient, and the benefits in this select group of patients outweigh the risks.
STUDY DESIGN: A retrospective study of patients with rigid coronal decompensation. OBJECTIVES: To determine if patients with rigid coronal decompensation can be safely and successfully treated by anterior-posterior vertebral column resection, spinal shortening, posterior instrumentation, and fusion to correct their deformities. SUMMARY OF BACKGROUND DATA: Previous investigators have described reconstructive techniques used to treat patients with sagittal and coronal spine deformities. These techniques include osteotomy and anterior or posterior fusion. Although a number of these studies consider the problems associated with failed back syndrome (flatback, coronal and axial imbalance, pseudarthrosis), they have not satisfactorily addressed the management of rigid coronal decompensation. The patient population of the current study, on average, presented with more severe, fixed deformities than those detailed in the literature, and required more extensive surgery than previously described. METHODS: Twenty-four patients (average age, 27 years) with rigid coronal decompensation underwent anterior-posterior vertebral column resection, spinal shortening, posterior instrumentation, and fusion. Degree of curvature was measured in the coronal and sagittal planes, and decompensation was assessed. Follow-up was from 2 to 10 years. RESULTS: Coronal and sagittal decompensation were corrected an average of 82% and 87%, respectively; T1 tilt and pelvic obliquity were improved by 65% and 53%, respectively; and scoliosis was improved by 52%. Complications occurred in 14 patients, but at follow-up all patients rated their results as either good or excellent. CONCLUSIONS:Patients with fixed, decompensated spinal deformity may be safely corrected by vertebrectomy, decancellation, spinal shortening, instrumentation, and fusion. Complications are transient, and the benefits in this select group of patients outweigh the risks.