Anterior spinal osteotomy and bone grafting

Anterior spinal osteotomy and bone grafting are used for the surgical treatment of congenital kyphosis. Congenital kyphosis and vertebral segmentation due to vertebral malformation are less common, but can cause severe spinal deformity and dysfunction (Figure 12.29.3.2-0-1). The classification of this disease helps to judge prognosis and guide treatment: type 1I, caused by defects in vertebral body formation, often occurs in the thoracic or thoracolumbar segments. This type is mostly progressive, and the development speed is increased by an average of 7° per year. Most of the spine bulging and paraplegia are of this type. Type 2 II, accompanied by poor vertebral body segmentation. The average progress is 5° per year. There are no reports of concurrent neurological symptoms in this model. The patient was often seen for pain in the lower back and poor appearance. Lower back pain is caused by compensatory lumbar lordosis. Type 3III, which is a mixture of Type I and Type II. Non-surgical treatment such as brace is not effective for this disease. Surgical methods vary, depending on the type of deformity, the severity of the spine, the age of the patient at the time of the visit, and the presence or absence of neurological symptoms. Type I should be treated early because of possible paraplegia. It is advisable to use the Moe articular surface fusion method for spinal fusion at the age of 1 to 3 years. The patient was fixed with a plaster vest for 12 months. This age group is fused after the rear, and the posterior deformity will be improved. Therefore, it is not advisable to perform front fusion. The younger the age, the bone allografts of the bone bank are often required. It is still possible to post-spinning fusion of the spine within 50° after the child over 5 years old. The posterior apex is often composed of several hypoplastic vertebral bodies, and the intervertebral body is firmly connected. Therefore, the head ring femoral traction or the head ring pelvis traction method should not be used in most type I patients. The paraplegic system is compressed by the vertebral body in front of the spinal cord. Once pulled, the spinal cord will move forward to make the compression worse. Posterior laminectomy does not help. Treatment of diseases: spinal cord injury congenital scoliosis Indication Anterior spinal osteotomy and bone grafting are applicable to: 1. Type II patients, where the posterior stenosis is heavy, the anterior spine osteotomy should be performed first to relieve the bone deformity. 2. Congenital kyphosis deformity combined with spinal cord compression. 3. When the patient's age at the first visit is more than 15 years old and the kyphosis angle has exceeded 60°, a second-stage surgical treatment is required. In the first stage, the anterior approach is performed, and the osteotomy of the segmental obstacle bone block (or the front bone bridge) is performed, and the bone graft is supported at the same time. After 2 to 3 weeks, the posterior operation is performed, and the double Harrington pressure is commonly used. Device. Contraindications 1. Highly reverse rotatory kyphosis is a kyphosis as a whole, but it is a lordotic deformity from the relationship between the vertebral bodies. In the anterior and lateral radiographs, the laterally curved apex and the kyphosis apical vertebrae are identical, requiring only posterior surgery without anterior fusion. 2. The patient's general condition, such as poor lung function or other important organ function, cannot tolerate the operator. Preoperative preparation 1. Generally not suitable for traction. Because the spinal cord has been strained by kyphosis, it tends to aggravate spinal cord injury when pulled. 2. Calculate the osteotomy range from the X-ray film. 3. Electrophysiological examination to make electromyography of the paraspinal muscles and lower limbs, to understand the degree of spinal nerve injury, as a comparison of intraoperative monitoring and postoperative follow-up. 4. Pulmonary function determination of lung activity below 60%, must undergo lung function training, until the lung capacity is more than 60%, then consider surgery, can reduce the risk of postoperative pulmonary complications. 5. Blood biochemical examination to check blood potassium, sodium, chlorine, blood gas and liver and kidney function, to understand the basic conditions of the body. 6. Application of antibiotics A sufficient amount of broad-spectrum antibiotics was given 24 hours before surgery. Surgical procedure Incision A chest-abdominal incision was used, the length of which was determined according to the extent of osteotomy determined by preoperative X-ray films. 2. Reveal the vertebral body and osteotomy The ribs were removed by conventional open chest approach and retained as bone grafting material. The incision was retracted with an automatic retractor. The intercostal blood vessels were ligated, and the vertebral body was exposed by subperiosteal dissection. The posterior convex midpoint was centered, and the thickened anterior longitudinal ligament was separated and cut. The bone bridge is gradually cut off with a quick drill or a rongeur. If the upper and lower vertebral bodies are completely fused, it should be cut off from the front and the back. When approaching the posterior longitudinal ligament, the operation should be especially careful. Because sometimes the posterior longitudinal ligament is absent, the operation may directly cause spinal cord injury. If the posterior longitudinal ligament is present, it is cut open until the dura is visible. Then, the upper, lower and both sides are enlarged to reveal the entire bone tissue under pressure. 3. Embed bone graft After the compression of the compressed vertebral body is completed, the appropriate length of the humerus is taken or the removed rib is cut into bone pieces and inserted into the upper and lower vertebral bodies of the decompression site, and the vertebral cancellous bone is hollowed out with a curette. A small bone groove is formed at the upper and lower normal vertebral bodies, and the removed rib or the humerus block is longitudinally embedded in the bone groove, and the bone block is pressed by hand to support the posterior process. Thoroughly fill the bone or bone at all osteotomy and, if possible, suture the pleura on the surface of the vertebral body. 4. Close the incision Complete hemostasis, saline flushing, chest drainage and negative pressure drainage tube. The incision was sutured layer by layer. complication 1. Spinal cord injury should be removed a small number of times when the vertebral body is scraped. Be careful when approaching the posterior longitudinal ligament. When the posterior longitudinal ligament is removed, the spinal cord is more likely to be damaged. 2. Poor healing of the vertebral body osteotomy The implanted bone tissue is insufficient or the longitudinal support bone graft is loose, which affects the stability of the spine. 3. Blood pneumothorax.