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Outcomes of 360° Osteotomy in the Cervicothoracic Spine (C7-T1) for Congenital Cervicothoracic Kyphoscoliosis in Children.
J Bone Joint Surg Am 2019; 101(15):1357-1365JB

Abstract

BACKGROUND

There have been many reports on the treatment of congenital kyphoscoliosis. However, congenital deformities in the cervicothoracic spine (C7-T1) have not been well described because of the rarity of these conditions.

METHODS

The medical records and imaging studies of 25 children who were treated with 360° osteotomy for congenital deformities in the cervicothoracic spine (C7-T1) at a mean age of 11.4 years were reviewed.

RESULTS

All 25 children presented with torticollis; 4 presented with neck pain; 10, with facial asymmetry; and 3, with preoperative neurological deficits. Twenty-three patients had congenital deformities in other regions of the spine. Six patients had a total of 8 intraspinal deformities. On average, the cervicothoracic curve was corrected from 53° preoperatively to 14° at the latest follow-up, the segmental kyphosis was corrected from 25° to 12°, and the head tilt improved from 25° to 5°. Nineteen patients had a total of 28 complications, including 1 transient cord injury together with a permanent C8 nerve root injury, 11 transient nerve root injuries, 1 transient Horner syndrome, 9 cases of decompensation of a compensatory curve, 2 implant failures, 2 cases of hemothorax, 1 dural tear, and 1 case of delayed wound-healing.

CONCLUSIONS

Most congenital cervicothoracic deformities are fixed, and early surgical intervention may be needed. A 360° osteotomy is indicated for this type of rigid deformity and may provide satisfactory correction. However, 360° osteotomy in the cervicothoracic spine (C7-T1) is technically demanding with a higher risk of nerve root injuries, although most injuries tend to be transient. If the compensatory thoracic curve is severe and rigid, 1-stage or staged surgery in this region may be required.

LEVEL OF EVIDENCE

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Authors+Show Affiliations

Department of Orthopedics, Peking Union Medical College Hospital, Beijing, People's Republic of China.Department of Orthopedics, Peking Union Medical College Hospital, Beijing, People's Republic of China.Department of Orthopedics, Peking Union Medical College Hospital, Beijing, People's Republic of China.Department of Orthopedics, Peking Union Medical College Hospital, Beijing, People's Republic of China.Department of Orthopedics, Peking Union Medical College Hospital, Beijing, People's Republic of China.Department of Orthopedics, Peking Union Medical College Hospital, Beijing, People's Republic of China.Department of Orthopedics, Peking Union Medical College Hospital, Beijing, People's Republic of China.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31393426

Citation

Wang, Shengru, et al. "Outcomes of 360° Osteotomy in the Cervicothoracic Spine (C7-T1) for Congenital Cervicothoracic Kyphoscoliosis in Children." The Journal of Bone and Joint Surgery. American Volume, vol. 101, no. 15, 2019, pp. 1357-1365.
Wang S, Lin G, Yang Y, et al. Outcomes of 360° Osteotomy in the Cervicothoracic Spine (C7-T1) for Congenital Cervicothoracic Kyphoscoliosis in Children. J Bone Joint Surg Am. 2019;101(15):1357-1365.
Wang, S., Lin, G., Yang, Y., Cai, S., Zhuang, Q., Tian, Y., & Zhang, J. (2019). Outcomes of 360° Osteotomy in the Cervicothoracic Spine (C7-T1) for Congenital Cervicothoracic Kyphoscoliosis in Children. The Journal of Bone and Joint Surgery. American Volume, 101(15), pp. 1357-1365. doi:10.2106/JBJS.18.01428.
Wang S, et al. Outcomes of 360° Osteotomy in the Cervicothoracic Spine (C7-T1) for Congenital Cervicothoracic Kyphoscoliosis in Children. J Bone Joint Surg Am. 2019 Aug 7;101(15):1357-1365. PubMed PMID: 31393426.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcomes of 360° Osteotomy in the Cervicothoracic Spine (C7-T1) for Congenital Cervicothoracic Kyphoscoliosis in Children. AU - Wang,Shengru, AU - Lin,Guanfeng, AU - Yang,Yang, AU - Cai,Siyi, AU - Zhuang,Qianyu, AU - Tian,Ye, AU - Zhang,Jianguo, PY - 2019/8/9/entrez PY - 2019/8/9/pubmed PY - 2019/8/9/medline SP - 1357 EP - 1365 JF - The Journal of bone and joint surgery. American volume JO - J Bone Joint Surg Am VL - 101 IS - 15 N2 - BACKGROUND: There have been many reports on the treatment of congenital kyphoscoliosis. However, congenital deformities in the cervicothoracic spine (C7-T1) have not been well described because of the rarity of these conditions. METHODS: The medical records and imaging studies of 25 children who were treated with 360° osteotomy for congenital deformities in the cervicothoracic spine (C7-T1) at a mean age of 11.4 years were reviewed. RESULTS: All 25 children presented with torticollis; 4 presented with neck pain; 10, with facial asymmetry; and 3, with preoperative neurological deficits. Twenty-three patients had congenital deformities in other regions of the spine. Six patients had a total of 8 intraspinal deformities. On average, the cervicothoracic curve was corrected from 53° preoperatively to 14° at the latest follow-up, the segmental kyphosis was corrected from 25° to 12°, and the head tilt improved from 25° to 5°. Nineteen patients had a total of 28 complications, including 1 transient cord injury together with a permanent C8 nerve root injury, 11 transient nerve root injuries, 1 transient Horner syndrome, 9 cases of decompensation of a compensatory curve, 2 implant failures, 2 cases of hemothorax, 1 dural tear, and 1 case of delayed wound-healing. CONCLUSIONS: Most congenital cervicothoracic deformities are fixed, and early surgical intervention may be needed. A 360° osteotomy is indicated for this type of rigid deformity and may provide satisfactory correction. However, 360° osteotomy in the cervicothoracic spine (C7-T1) is technically demanding with a higher risk of nerve root injuries, although most injuries tend to be transient. If the compensatory thoracic curve is severe and rigid, 1-stage or staged surgery in this region may be required. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. SN - 1535-1386 UR - https://www.unboundmedicine.com/medline/citation/31393426/Outcomes_of_360°_Osteotomy_in_the_Cervicothoracic_Spine_(C7-T1)_for_Congenital_Cervicothoracic_Kyphoscoliosis_in_Children L2 - http://Insights.ovid.com/pubmed?pmid=31393426 DB - PRIME DP - Unbound Medicine ER -