刚性颈胸脊柱后凸畸形(CTKD)仍然是一种难以治疗的病理,特别是在设置之前的颈椎器械和融合。CTKD可能导致慢性颈痛,难以保持水平凝视,和脊髓病。先前的研究提倡使用C7或T1椎弓根减骨术(PSO)。然而,这些手术充满了危险,最重要的是,将C7、C8和/或T1神经根置于危险中。
作者回顾性回顾了他们进行T2PSO矫正刚性CTKD的经验。收集的人口统计数据包括年龄,性别,之前宫颈手术的细节,和共存的条件。围手术期变量包括减压水平,水平仪表,估计失血量,手术长度,逗留时间,手术并发症,和后续时间。射线照相测量包括C2-7矢状垂直轴(SVA)校正,颈胸Cobb角的变化,腰椎前凸,和C2-S1SVA。
确定了4名男性患者(年龄范围55-72岁)。三名患者先前进行了颈椎后路椎板切除术和器械融合,并发生了术后脊柱后凸畸形。所有患者均接受T2PSO:2例患者在C2-T4接受仪器治疗,2例患者在C2-T5接受仪器治疗。中位数C2-7SVA校正为3.85cm(范围2.9-5.3cm)。矢状Cobb角校正范围为27.8°至37.6°。值得注意的是,没有神经系统并发症。
T2PSO是一种用于治疗刚性CTKD的强大校正技术。与C7或T1PSO相比,内部手部肌肉神经支配损伤的风险降低,几乎没有椎动脉损伤的风险。椎板切除术也可能更安全,因为先前手术的疤痕组织较少(或没有)。在该远端水平处的校正可以允许更大的矢状校正。作者乐观地认为,这些发现将在检查这一具有挑战性的临床实体的更大队列中得到证实。
Rigid cervicothoracic kyphotic deformity (CTKD) remains a difficult pathology to treat, especially in the setting of prior cervical instrumentation and fusion. CTKD may result in chronic neck pain, difficulty maintaining horizontal gaze, and myelopathy. Prior studies have advocated for the use of C7 or T1 pedicle subtraction osteotomies (PSOs). However, these surgeries are fraught with danger and, most significantly, place the C7, C8, and/or T1 nerve roots at risk.
The authors retrospectively reviewed their experience with performing T2 PSO for the correction of rigid CTKD. Demographics collected included age, sex, details of prior cervical surgery, and coexisting conditions. Perioperative variables included levels decompressed, levels instrumented, estimated blood loss, length of surgery, length of stay, complications from surgery, and length of follow-up. Radiographic measurements included C2-7 sagittal vertical axis (SVA) correction, and changes in the cervicothoracic Cobb angle, lumbar lordosis, and C2-S1 SVA.
Four male patients were identified (age range 55-72 years). Three patients had undergone prior posterior cervical laminectomy and instrumented fusion and developed postsurgical kyphosis. All patients underwent T2 PSO: 2 patients received instrumentation at C2-T4, and 2 patients received instrumentation at C2-T5. The median C2-7 SVA correction was 3.85 cm (range 2.9-5.3 cm). The sagittal Cobb angle correction ranged from 27.8° to 37.6°. Notably, there were no neurological complications.
T2 PSO is a powerful correction technique for the treatment of rigid CTKD. Compared with C7 or T1 PSO, there is decreased risk of injury to intrinsic hand muscle innervators, and there is virtually no risk of vertebral artery injury. Laminectomy may also be safer, as there is less (or no) scar tissue from prior surgeries. Correction at this distal level may allow for a greater sagittal correction. The authors are optimistic that these findings will be corroborated in larger cohorts examining this challenging clinical entity.