Thoracolumbar scoliosis and kyphosis are the most common clinical deformities of the spine. The causes include congenital (congenital lateral and posterior hemivertebrae, which can develop in infancy and childhood), idiopathic (common in adolescents over 10 years of age), spinal specific and nonspecific infections (tuberculosis of the spine, septic infection, etc.), immune diseases (ankylosing spondylitis), trauma (spinal fractures that are not well treated, resulting in deformity healing), and medically induced kyphosis (spinal surgery in childhood or adolescence). (spinal fractures that are not treated well and result in deformity healing), and medically induced kyphosis (spinal surgery in childhood or adolescence).
There are many methods to correct scoliosis and kyphosis, and patients with a small scoliosis angle can obtain a good correction by simply using the orthopedic force of the pedicle nail and rod. In the 1990s, Qilu Hospital of Shandong University was the first in China to carry out orthopedic internal fixation surgery with pedicle nails and rods. The thoracic arch nailing technique, de-rotation technique, and selective nail placement were adopted earlier in China to further improve the orthopedic effect and reduce the surgical cost while ensuring the safety of the corrective surgery (Figure 1). Early detection and early surgery can effectively reduce the extent of spinal fusion, minimize surgical trauma, and help minimize the impact of orthopedic surgery on the development of the child.
The left picture is a preoperative X-ray. The right picture shows that the orthopedic treatment is satisfactory and the selective placement of screws saves the cost of surgery.
For cases with large lateral and posterior convexity, it is difficult to correct them simply by the power of screws and rods, and osteotomy is required to obtain satisfactory correction. Currently, the main osteotomy methods for scoliosis and kyphosis include Smith-Petersen osteotomy (SPO), Ponte osteotomy, transpedicular arch osteotomy (PSO), closed-open wedge osteotomy (COWO), total spinal resection (VCR) and total spinal debridement osteotomy (VCD). Regardless of the surgical approach, the concern of the surgeon, patient and family is to maximize the correction of the deformity while ensuring the safety of the spinal cord (nerves).
By and large, SPO and Ponte osteotomies have the least potential for spinal cord injury because they remove only the posterior spinal structures, but the disadvantage is that these two osteotomies are limited in the angles they can correct (Figure 2).
The left image shows the posterior bony structures revealed during surgery, and the blue arrow on the right image shows that some of the posterior bone has been removed
Correction of more angular deformities requires the use of trans-arch osteotomy (PSO), closed-open wedge osteotomy (COWO), total vertebral resection (VCR) and total spinal debridement osteotomy (VCD), all of which require removal of the posterior structures followed by resection of part of the deformed vertebral body from the lateral to the anterior side of the spinal cord, thus correcting the deformity at a greater angle. This surgical approach also increases the risk of spinal cord injury and vascular damage to some extent.
The blue arrow shows that the spinal cord needs to be bypassed in the middle when the bone is removed anteriorly (brown)
After many years of clinical summary and improvement, we have adopted the “eggshell” technique and the expanded “eggshell” technique to treat a large number of patients with severe scoliosis and kyphosis, and clinical practice has confirmed that safety and deformity correction are guaranteed and can effectively The clinical practice has shown that the safety and deformity correction are guaranteed and the bleeding volume of osteotomy can be effectively reduced (Figure 3). Our clinical study was published in the Journal of Neurosurgery Spine, USA.
A-F is a diagram of our use of the expanded “eggshell” technique for correction of kyphosis
Typical case: kyphosis
Pre-operative severe kyphosis Post-operative complete correction of the deformity Post-operative CT shows complete release of spinal cord compression
Typical case 2: Scoliosis
Typical case 3: congenital scoliosis
Preoperative CT Two years after surgery, satisfactory correction of the deformity was seen