Early one-stage posterior-only surgery for congenital cervicothoracic scoliosis in children: medium- and long-term follow-up.

IF 1.6 4区医学 Q2 SURGERY Frontiers in Surgery Pub Date : 2025-01-23 eCollection Date: 2025-01-01 DOI:10.3389/fsurg.2025.1473800

Cefei Zhang, Fuyun Liu, Ke Xu, Weiming Hu, Bing Xia, Yufeng Zhao

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Abstract

Objective: The purpose of this study is to investigate the medium- and long-term correction outcomes and complications of early one-stage posterior-only surgery for congenital cervicothoracic scoliosis in children.

Methods: From March 2006 to March 2022, we retrospectively investigated 33 consecutive cases of congenital cervicothoracic scoliosis treated by one-stage posterior-only surgery, including 15 males and 18 females, with a mean age of 3.2 years. Radiographic parameters, including segmental scoliosis, distal compensatory curve, T1 tilt, clavicle angle, neck tilt, coronal balance distance, segmental kyphosis, and sagittal vertical axis, were measured preoperatively, postoperatively, and at the last follow-up. The results of the measurements were statistically analyzed using paired-sample t-tests. Complications were recorded.

Results: The mean operation time was 199.8 min (100-340 min) with an average blood loss of 261.5 ml (80-600 ml). The mean follow-up period was 75.8 months (28-182 months). Fusion levels averaged 3.4 segments (2-6 segments). The segmental scoliosis was improved from 48.2° ± 10.7° preoperatively to 10.0° ± 6.0° postoperatively (P < 0.001), with a correction rate of 79.3% ± 11.2%. The distal compensatory curve was spontaneously corrected from 23.4° ± 9.8° preoperatively to 9.2° ± 5.7° postoperatively (P < 0.001), with a correction rate of 58.8% ± 19.4%. One case of pleural rupture, three cases of transient nerve root injury, one case of Horner syndrome, and two cases of pleural effusion. Two cases underwent revision surgery due to loss of correction.

Conclusion: Early one-stage posterior-only surgery for congenital cervicothoracic scoliosis in children can effectively correct the local deformities and improve the appearance, and the medium- and long-term correction outcomes are satisfactory. Hemivertebra resection without internal fixation may be considered for some very young children. For the higher level of thoracic hemivertebra, the osteotomy level being shifted down one vertebra is a feasible and safer surgical procedure.

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儿童先天性颈胸侧凸的早期一期单纯后路手术：中长期随访。

目的：探讨儿童先天性颈胸侧凸早期一期单纯后路手术的中长期矫正效果及并发症。方法：自2006年3月至2022年3月，对33例经一期单纯后路手术治疗的先天性颈胸侧凸患者进行回顾性分析，其中男性15例，女性18例，平均年龄3.2岁。术前、术后及最后随访时测量影像学参数，包括节段性脊柱侧凸、远端代偿曲线、T1倾斜、锁骨角、颈部倾斜、冠状平衡距离、节段性后凸和矢状垂直轴。测量结果采用配对样本t检验进行统计分析。记录并发症。结果：平均手术时间199.8 min (100 ~ 340 min)，平均失血量261.5 ml （80 ~ 600 ml）。平均随访时间75.8个月（28 ~ 182个月）。融合水平平均为3.4节段（2-6节段）。节段性脊柱侧凸由术前48.2°±10.7°改善至术后10.0°±6.0°(P P结论：儿童先天性颈胸侧凸早期一期单纯后路手术可有效矫正局部畸形，改善外观，中长期矫正效果满意。对于一些非常年幼的儿童，可以考虑半椎体切除而不进行内固定。对于较高水平的胸半椎体，截骨水平下移一节椎体是一种可行且安全的手术方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Frontiers in Surgery Medicine-Surgery

CiteScore

1.90

自引率

11.10%

发文量

1872

审稿时长

12 weeks

期刊介绍： Evidence of surgical interventions go back to prehistoric times. Since then, the field of surgery has developed into a complex array of specialties and procedures, particularly with the advent of microsurgery, lasers and minimally invasive techniques. The advanced skills now required from surgeons has led to ever increasing specialization, though these still share important fundamental principles. Frontiers in Surgery is the umbrella journal representing the publication interests of all surgical specialties. It is divided into several “Specialty Sections” listed below. All these sections have their own Specialty Chief Editor, Editorial Board and homepage, but all articles carry the citation Frontiers in Surgery. Frontiers in Surgery calls upon medical professionals and scientists from all surgical specialties to publish their experimental and clinical studies in this journal. By assembling all surgical specialties, which nonetheless retain their independence, under the common umbrella of Frontiers in Surgery, a powerful publication venue is created. Since there is often overlap and common ground between the different surgical specialties, assembly of all surgical disciplines into a single journal will foster a collaborative dialogue amongst the surgical community. This means that publications, which are also of interest to other surgical specialties, will reach a wider audience and have greater impact. The aim of this multidisciplinary journal is to create a discussion and knowledge platform of advances and research findings in surgical practice today to continuously improve clinical management of patients and foster innovation in this field.