One Stage Spinal Osteotomies For Congenital Severely Scoliosis Associated With Split Spinal Cord Malformation

ObjectiveTo analyze the safety and efficacy of one stage spinal osteotomies for29consecutive patients, who had progressive severe and rigid congenital scoliosis (CS) associated with split spinal cord malformation (SSCM).MethodsA total of29patients underwent one stage spinal osteotomies for severe and rigid CS associated with SSCM from September2007to November2010in our hospital. Of the29patients,11were males and18were females with an average age of15.6±3.3years (range,12-28years). There were11patients with Type I SSCM and18patients with Type Ⅱ SSCM. The mean major coronal curve ranged from80°to154°(average,97.2°±17.8°) and the coronal flexibility ranged from4.0%to28.3%,(average,13.4%±7.5%). Before the corrective stage of surgery, the bony spur was resected in patients of Type I SSCM, while nothing was done to the Type Ⅱ SSCM. Then, posterior osteotomy and fusion surgery were performed to correct the spinal deformity. ResultsPatients were followed up for a minimum of24months after initial surgical treatment with an average follow-up of43.0±17.1months (range,24-68months). The average operation time was553.6±112.9min (range,395-895min) and the average blood loss was3520.7±2154.3ml (range,1000-9600ml). Average amount of blood transfusion was3541.4±1933.6ml (range,800-8850ml). The immediate postoperative correction rate was47.2%-96.7%(average,64.3%±11.0%). At final follow-up, the final correction rate of61.2%±11.5%(range,40.7%-94.5%) and a correction loss of2.9%±2.3%(range,0.3%-8.9%). The overall major surgical complications rate was24.1%(7/29), including neurological deterioration in3patients (10.3%,3/29), cerebrospinal fluid leakage in2patients (6.9%,2/29), pleural rupture in1patients (3.4%,1/29), urinary tract infection in1patient (3.4%,1/29). Neurological deterioration recovered to the preoperative neurological status at1week,3months and6months postoperatively and improved at the final follow-up compared with preoperative status.ConclusionOne stage spinal osteotomies is safe and effective for the severe and rigid CS with SSCM without increasing complication rate. However, one stage resulting in longer operative time and greater blood loss.