The utilization of Scoliosis Research Society-Schwab grade VI osteotomy and satellite rod technique in severe angular kyphosis: short-term outcomes and complications analysis
10.3760/cma.j.cn121113-20230405-00206
- VernacularTitle:SRS-SchwabⅥ级截骨术联合卫星棒技术治疗严重脊柱角状后凸畸形的短期疗效
- Author:
Yutong DAI
1
;
Benlong SHI
;
Zhen LIU
;
Xu SUN
;
Yong QIU
;
Zezhang ZHU
Author Information
1. 南京大学医学院附属鼓楼医院骨科脊柱外科，南京 210008
- Keywords:
Kyphosi;
Osteotomy;
Treatment outcome;
Intraoperative complications;
Postoperative complications
- From:
Chinese Journal of Orthopaedics
2023;43(20):1354-1361
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the therapeutic efficacy and safety of SRS-Schwab Grade VI osteotomy in the management of severe angular kyphosis and to assess perioperative and postoperative complications.Methods:A comprehensive retrospective analysis was conducted on 19 patients diagnosed with severe angular kyphosis who underwent SRS-Schwab Grade VI osteotomy between June 2011 and June 2021. Various radiographic parameters, including global kyphosis (GK), sagittal vertical axis (SVA), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic tilt (PT), pelvic incidence (PI), and sacral slope (SS), were quantified through standing radiographs obtained preoperatively, postoperatively, and at the most recent follow-up. Incidences of intraoperative and postoperative complications were meticulously recorded. The Scoliosis Research Society-22 (SRS-22) score was utilized to gauge patient quality of life, while neurological function was appraised using the American Spinal Injury Association (ASIA) grading system.Results:The mean follow-up duration was 24.9±9.5 months, ranging from 12 to 49 months. The intraoperative blood loss averaged 2 995.3±1 357.6 ml, with a mean operative time of 414.5±65.8 minutes. The osteotomy was performed across an average of 2.4±0.6 segments, with 11.0±1.7 segments subsequently fused. Statistically significant alterations were observed in multiple parameters including GK ( F=658.56, P<0.001), SVA ( F=18.86, P<0.001), LL ( F=180.73, P<0.001), TK ( F=166.12, P<0.001), PT ( F=14.68, P<0.001), and SS ( F=6.03, P=0.005) when compared at preoperative, immediate postoperative, and ultimate follow-up intervals. PI remained statistically invariable ( F=0.29, P=0.750). Preoperative mean values for GK and SVA were 107.4°±9.1° and 38.4±19.7 mm, respectively. Postoperatively, GK was dramatically reduced to 39.7°±12.1° ( t=25.59, P<0.001), reflecting a correction rate of 63.2%±10.1%. Concurrently, SVA was markedly improved to 18.1±10.6 mm ( t=4.22, P=0.001). Notably, the correction remained stable during subsequent follow-ups. Functional and self-image domain scores exhibited a significant elevation at the final follow-up in comparison to preoperative values. Seven patients experienced intraoperative neurophysiological monitoring events, but no enduring neurological deficits were discerned postoperatively. A singular case of postoperative neurological impairment was attributed to spinal cord hematoma. Moreover, proximal junctional kyphosis (PJK) manifested in six patients during follow-up, while implant failure was conspicuously absent. Conclusion:SRS-Schwab Grade VI osteotomy demonstrates a commendable efficacy in the correction of severe angular kyphosis, with the resultant alignment proving to be durably maintained throughout the follow-up period.
