Evaluation of a combined approach to the correction of congenital cervical or cervicothoracic scoliosis

Spine J. 2019 May;19(5):803-815. doi: 10.1016/j.spinee.2018.11.006. Epub 2018 Nov 15.

Abstract

Background context: An anteroposterior combined approach has been used for the treatment of congenital cervical or cervicothoracic scoliosis. However, its outcomes and surgical risks have not been clarified.

Purpose: We analyzed the characteristics of congenital cervical and cervicothoracic scoliosis and evaluated the outcomes of an anteroposterior combined approach for its treatment.

Study design: We carried out a retrospective clinical study of prospectively collected data.

Patient sample: Sixteen patients were treated between 2009 and 2013. Their average age was 9.2years.

Outcome measures: Radiographic and surgical outcomes were measured and recorded. We compared morphological parameters and preoperative and postoperative results.

Methods: All patients underwent surgery with a combined approach. The following radiographic parameters were measured: head tilt (HT), mandible incline (MI), shoulder balance (SB), structural and compensatory curves, cervical lordosis, C7 central sacral vertical line (C7-CSVL) ratio, C7 sagittal vertical axis (C7-SVA) ratio, C2-C7 SVA ratio, the angle between the upper endplate of the T2 vertebra and a horizontal line (T2 tilt), gravity line ratio. Demographic and surgical data were also collected.

Results: On average, the duration of follow-up was 68.0 months, surgical blood loss was 675mL, and the duration of surgery was 400.5 minutes. The average correction rate was 64.9% in the structural curve and 29.5% in the compensatory curve. Statistical analysis showed that MI significantly correlated with HT and SB (p<.05). The C7-CSVL ratio correlated with the HT, MI, and SB (p<.05). The C7-SVA ratio correlated with the structural curve and cervical lordosis (p<.05), and the gravity line ratio correlated with the structural and compensatory curve, cervical lordosis, and C7-SVA ratio (p<.05). Moreover, there were correlations between the structural and compensatory curves as well as between the structural curve and cervical lordosis (p<.05). There were significant differences before and after surgery in HT, MI, and structural and compensatory curves. Four patients developed nerve root palsy after surgical correction and totally recovered by 6 months of follow-up.

Conclusion: The combined approach is an effective surgical option for congenital cervical or cervicothoracic scoliosis. The resection of the hemivertebra cannot only improve head-neck aesthetic appearance but can also maintain the growth potential of the neck.

Keywords: Aesthetic evaluation; Cervical scoliosis; Combined approach; Congenital hemivertebral deformity; Head tilt; Mandible incline.

Publication types

  • Evaluation Study

MeSH terms

  • Adolescent
  • Cervical Vertebrae / surgery
  • Child
  • Female
  • Humans
  • Male
  • Postoperative Complications / epidemiology*
  • Scoliosis / surgery*
  • Spinal Fusion / adverse effects
  • Spinal Fusion / methods*
  • Thoracic Vertebrae / surgery