Three columns vertebrotomies in extra-apical area as a method of surgical deformity correction of cervicothoracic transition: analysis of the clinical series and literature data

Abstract

Design: retrospective analysis of the clinical observations. Level of evidence – III. Aim: retrospective analysis of the treatment results of the patients with malformation and segmentation of the cervical and upper thoracic vertebrae. Materials and methods. Retrospective multi-center cohort of 8 cases aged from 8 to 15 years. Inclusive criteria are as follows: children aged less than 15 years by the time of operation, deformity in the frontal plane, application of three columns vertebrotomy and complete radiological archive availability. Results. Patients with multiple abnomalies with a leading component maldevelopment of vertebral segmentation and formation are predominated. There were no violations of sagittal balance in patients. The amount of scoliotic deformity according to Cobb ranged from 30 ° to 66 ° (mean value - 46.1 °), with a frontal imbalance in 6 (55,5%) patients. After operations scoliosis values were from 3 ° to 34 ° (mean value - 15.3 °). However in all cases after operation the frontal balance was restored. The amount of correction ranged from 49% to 90% (mean 69,4%). No permanent neurological complications were observed in peri- and post-operative periods. Conclusion. The key criterion for surgical correction of the defects of the cervicothoracic transition is the reconstruction of the local balance in the frontal and sagittal planes, and not the absolute correction of local deformation. Spine osteotomy in extra-apical area in children with multiple mal-developments of the cervical and upper thoracic spine allows us to produce adequate deformity correction (for mean 69,4%) and to reduce the risk of neurological disorders through main compression manipulation. That reduces the zone of instrumental fixation which is important for preservation of the axial growth.