Abstract
Study Design: Retrospective study.
Objective: To describe a modified cervico-thoracic extension osteotomy and evaluate clinical & radiographic outcomes.
Subjects: 10 patients with fixed cervico-thoracic kyphosis, average age 56 years, minimum 12 months follow-up. Three patients had psoriatic spondyloarthropathy, Three patients had previous lumbar osteotomies.
Technique: General anaesthesia and SSEP spinal cord monitoring was used. Complete laminectomy of C7, hemilaminectomy of C6 and T1, plus pedicle subtraction osteotomy and decancellisation of C7 was performed. Upon completion of the osteotomy, controlled halo manipulation allowed closure of the osteotomy: the pivot point being the anterior longitudinal ligament. Segmental fixation with lateral mass and pedicle screws plus bone graft was then added. All patients were immobilised for three months in halo-jacket.
Results: Restoration of normal forward gaze was achieved in all patients. Mean preoperative kyphosis of 17 degrees was corrected to lordosis of 36 degrees (mean total correction 53 degrees). No spinal cord injuries or permanent nerve root palsies occurred. Three patients had mild sensory radiculopathies lasting a few weeks. No loss of correction, no pseudarthrosis, one patient had 50% anterior subluxation that later united. Two deep infections were successfully treated with wound washout and antibiotics.
Conclusions: Cervico-thoracic osteotomy in ankylosing spondylitis continues to be challenging and hazardous. C7 decancellisation and extension osteotomy supplemented with segmental internal fixation provides immediate spinal stability, reduces sagittal spinal translation and associated high risk of neurological injury, whilst maintaining correction until bony union.
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.
