Abstract
Study design: Retrospective study.
Objectives: To determine whether apical vertebrectomy for correction of severe spinal deformity in patients with cerebral palsy or mental retardation significantly improves curve correction and to study complications of such a procedure.
Summary of Background data: Although a combined anterior-posterior procedure for correction of severe deformity in cerebral palsy patients is well established, apical vertebrectomy to improve correction has not been described.
Subjects: 5 patients (2M, 3F) operated on between 2000–2003 (anterior apical vertebrectomy followed by posterior instrumented fusion), mean age 14 years, average follow-up 1.5 years. All had group II (Lonstein & Akbarnia) rigid (mean 96degrees bending to 83degrees) thoracolumbar/lumbar curves with marked pelvic obliquity.
Results: Preoperative mean Cobb angle of 96 degrees corrected to 36 degrees, (63% correction, and 57% correction over and above the bending Cobb angle), 42 degrees at final follow-up. Mean apical vertebral translation (AVT) correction was 57 % (86mm to 37mm) and regional AVT correction 53%. Pelvic tilt correction was 72% (29degrees to 9degrees). Thoracic kyphosis remained unchanged but lumbar lordosis of 4.2 degrees (range−66 to +68) was corrected to 63 degrees. Mean blood loss was 1100mls (range 300–3000) for anterior surgery and 3400mls for posterior surgery. Operative time was 3 hours for anterior surgery. There were no intra-operative or post-operative complications (infection, pseudarthrosis, metalwork failure). Subjective outcome was excellent in all patients.
Conclusion: In patients with rigid, rotated curves with wide apical translation, apical vertebrectomy and posterior instrumented fusion can achieve significant correction of Cobb angle over and above the bending cobb angle and also the AVT and pelvic tilt leading to high parent / caregiver satisfaction and improvement in functional status of the patient.
These abstracts were prepared by Mr. Brian J C Freeman FRCS (Tr & Orth). Correspondence should be addressed to him at The Centre for Spinal Studies and Surgery, University Hospital, Queens Medical Centre, Nottingham NG7 2UH.
