ABSTRACT
Objective:
To investigate the surgical strategy of posterior correction of cervicothoracic
scoliosis in
children and
adolescents, and to analyze the curative effect of surgical correction.
Methods:
A
retrospective study was conducted on 14
patients with cervicothoracic
scoliosis who underwent surgical
treatment in the department of
spine surgery of our
hospital from January 2014 to June 2020, including 9
female and 5
male patients. 8
patients were treated with Halo
traction before
surgery.Among them, 7
patients were treated by posterior column
osteotomy and fusion
surgery, 7
patients were treated byposterior approach hemivertebra
osteotomy. The
scoliosis Cobb angle, T 1 tilt angle,
clavicle angle,
neck tilt angle,
shoulder height difference, sagittal balance distance, coronal balance distance and local
kyphosis angle were measured compared among before operation, after operation, at 1 year follow-up and at the last follow-up to evaluate the effect of surgical
treatment and the correction loss at follow-up. Intraoperative and
postoperative complications were recorded, and the
Scoliosis Research Society question naires-22 (SRS-22)
questionnaire was completed preoperatively and at 24-month follow-up to evaluate the
functional status and
treatment effect.
Results:
All 14
patients successfully completed the operation, the operation
time was 6.85±1.79 h (range, 5-11 h); the intraoperative
blood loss was 685.71±265.61 ml (range, 400-1 200 ml), and the follow-up
time was 37.28±13.75 months (range, 24-72 months). The Cobb angle of the main curve was 50.20°±15.19° preoperatively, 10.91°±6.46° postoperatively , 10.53°±6.42° at 1-year follow-up, and 10.14°±5.95° at the last follow-up, and the difference was statistically significant ( F=45.55, P<0.001), the preoperative and postoperative difference was statistically significant ( t=10.62, P<0.001) with a correction rate of 78.32%±11.41%. The T 1 inclination angle was 16.08°±8.06° before operation, 3.71°±2.40° after operation, 4.05°±1.94° at 1-year follow-up, and 3.97°±2.04° at the last follow-up, and the difference was statistically significant ( F=10.55, P=0.001), the preoperative and postoperative difference was statistically significant ( t=6.37, P<0.001) with a correction rate of 69.56%±25.86%. The
neck tilt angle was 7.45°±3.72° before operation, 2.45°±1.12° after operation, 2.75°±0.89° at 1-year follow-up, and 3.10°±2.01° at the last follow-up, and the difference was statistically significant ( F=6.65, P=0.008), in which postoperative correction rate was 57.92%±25.41%, and the difference was statistically significant ( t=4.69, P<0.001). The data of
shoulder height difference before operation did not conform to
normal distribution (Shapiro-Wilk test, P=0.017), it was 0.97 (0.54, 1.32) cm before operation and 0.53±0.40 cm after operation, and the postoperative correction rate was 50.17%±27.38%, the difference was statistically significant ( Z=3.18, P=0.001). The total score of SRS-22
questionnaire was increased from 4.21±0.29 preoperatively to 4.81±0.17 at 24-month follow-up ( t=7.35, P<0.001). Except for one
patient with
transient upper limb numbness, the other 13
patients showed no obvious intraoperative or
postoperative complications.
Conclusion:
Both posterior column
osteotomy with fusion and posterior hemivertebra
osteotomy are effective in the
treatment of cervicothoracic
scoliosis, and the surgeon can make individual
treatment plans according to different conditions.