201 - The Application of One Stage 360 Degree Osteotomy in the Treatment of...

#201 The Application of One Stage 360 Degree Osteotomy in the Treatment of Congenital Torticollis Due to Wedge or Butterfly Vertebrae

Pediatric Spine

Poster Presented by: Y. Sun

Author(s):

Y. Sun (1)
F. Zhang (1)
S. Pan (1)
Y. Diao (1)
X. Chen (1)
F. Zhou (1)
Y. Zhao (1)

(1) Peking University Third Hospital, Orthopaedic Surgery, Beijing, China

Abstract

Objective: The one stage 360 degree osteotomy was performed to treat the congenital torticollis due to cervical or cervical-thoracic scoliosis deformities as the result of wedge or butterfly shaped vertebrae. The safety and feasibility were evaluated. The early and midterm clinical outcomes were reported.

Method: The congenital torticollis presented with newborn. The main pathology included cervical or / and upper thoracic malformation with wedge shaped hemi-vertebrae or uneven butterfly shaped vertebrae. It is often complicated with congenital fusion of the partial spinal elements or retardant vertebrae. The cervical scoliosis is gradually getting worse as the child growing up. The face becomes asymmetrical and the development of vision system will be influenced. The conservative treatment has no effect. The growing block procedure of hemi-vertebrae has little effect.

The operation was performed under general anesthesia. Anterior approach was used. The vertebral body of hemi-vertebra of convex side was completely removed with high-speed bur. The vertebral body of butterfly shaped vertebra of convex side was partially removed. The anterior part of transverse process was also removed. The vertebral artery and nerve root were exposed and protected. The residual disc and part of congenital fused vertebrae of concave side were excised and cut off. The posterior longitudinal ligament was incised. The anterior part of 360 degree osteotomy finished.

The patient was turned to prone position with Mayfield frame skull traction. The pedicle screw was applied and fixed temporarily on the upper and lower levels. The lamina of hemi-vertebra of convex side was completely removed with high-speed bur. The lamina of butterfly shaped vertebra of convex side was partially removed. The facet joint and posterior part of transverse process was also removed. The nerve root and vertebral artery were exposed and protected. The congenital fused lamina on concave side was cut off. The yellow ligament was incised. The 360 degree osteotomy finished. The compression on the convex side and distraction on the concave side were performed with the assistance of rotation and distraction of Mayfield traction frame. The correction of torticollis finished. The Halo-vest was applied or an ACDF was performed.

Result: Ten patients with average age of 8 years old (5-11) were treated. There were six male and four female. Eight cases had cervical scoliosis and two cases had cervical-thoracic scoliosis. There were four patients complicated cranial-cervical junction deformities. The pre-op cob angle was 23-45 degrees. Two cases had anterior-posterior osteotomy with Halo-vest immobilization for three months. Eight cases had anterior-posterior-anterior osteotomy with soft collar for 6 weeks. The average operating time was 6 hr.25 min. with average blood loss 600ml. Four cases had MEP and SEP monitoring during the surgery. Two cases had temporary convex side nerve root symptoms post-operatively. The average follow-up period was 18 months (3-36 months). Post-op Cobb's angle was 3.5 degrees on average at final follow up. The patient's appearance improved significantly after the surgery. Two patients still have some neck tilt intendance due to vision convention.

Conclusion: The one stage 360 degree osteotomy for the treatment of the congenital torticollis is safe and feasible. The early and midterm clinical outcomes were satisfactory.