Journal of Korean Neurosurgical Society

  • 제61권6호
  • /
  • Pages.723-730
  • /
  • 2018
  • /
  • 2005-3711(pISSN)
  • /
  • 1598-7876(eISSN)
대한신경외과학회 (The Korean Neurosurgical Society)
권호 표지
DOI QR코드

DOI QR Code

Total Deformity Angular Ratio as a Risk Factor for Complications after Posterior Vertebral Column Resection Surgery

  • Lee, Byoung Hun (Department of Neurosurgery, Hallym University Hangang Sacred Heart Hospital) ;
  • Hyun, Seung-Jae (Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Han, Sanghyun (Department of Neurosurgery, Chungnam National University Hospital, Chungnam National University College of Medicine) ;
  • Jeon, Se-Il (Department of Neurosurgery, Spine Center, Hyundai UVIS Hospital) ;
  • Kim, Ki-Jeong (Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Jahng, Tae-Ahn (Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Kim, Hyun-Jib (Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine)
  • 투고 : 2018.06.02
  • 심사 : 2018.07.21
  • 발행 : 2018.11.01
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Objective : The aim of the present study was to identify whether the deformity angular ratio (DAR) influences the occurrence of complications after posterior vertebral column resection (PVCR) and to establish the DAR cut-off value. Methods : Thirty-six consecutive patients undergoing PVCR from December 2010 to October 2016 were reviewed. The relationships between the total, sagittal, and coronal DAR and complications were assessed using receiver operator characteristics curves. The patients were divided into two groups according to a reference value based on the cut-off value of DAR. Demographic, surgical, radiological, and clinical outcomes were compared between the groups. Results : There were no significant differences in the patient demographic and surgical data between the groups. The cut-off values for the total DAR (T-DAR) and the sagittal DAR (S-DAR) were 20.2 and 16.4, respectively (p=0.018 and 0.010). Both values were significantly associated with complications (p=0.016 and 0.005). In the higher T-DAR group, total complications (12 vs. 21, p=0.042) and late-onset complications (3 vs. 9, p=0.036) were significantly correlated with the T-DAR. The number of patients experiencing complications (9 vs. 11, p=0.029) and the total number of complications (13 vs. 20, p=0.015) were significantly correlated with the S-DAR. Worsening intraoperative neurophysiologic monitoring was more frequent in the higher T-DAR group (2 vs. 4) than in the higher S-DAR group (3 vs. 3). There was no difference in neurological deterioration between the groups after surgery. Conclusion : Both the T-DAR and the S-DAR are risk factors for complications after PVCR. Those who had a T-DAR >20.2 or S-DAR >16.4 experienced a higher rate of complications after PVCR.

키워드

참고문헌

  1. Boachie-Adjei O, Bradford DS : Vertebral column resection and arthrodesis for complex spinal deformities. J Spinal Disord 4 : 193-202, 1991 https://doi.org/10.1097/00002517-199106000-00010
  2. Bradford DS, Tribus CB : Vertebral column resection for the treatment of rigid coronal decompensation. Spine (Phila Pa 1976) 22 : 1590-1599, 1997 https://doi.org/10.1097/00007632-199707150-00013
  3. Demirkiran G, Dede O, Karadeniz E, Olgun D, Ay vaz M, Yazici M : Anterior and posterior vertebral column resection versus posterior-only technique: a comparison of clinical outcomes and complications in congenital kyphoscoliosis. Clin Spine Surg 30 : 285-290, 2016
  4. Enercan M, Ozturk C, Kahraman S, Sarier M, Hamzaoglu A, Alanay A : Osteotomies/spinal column resections in adult deformity. Eur Spine J 22 Suppl 2 : S254-S264, 2013 https://doi.org/10.1007/s00586-012-2313-0
  5. Hamzaoglu A, Alanay A, Ozturk C, Sarier M, Karadereler S, Ganiyusufoglu K : Posterior vertebral column resection in severe spinal deformities: a total of 102 cases. Spine (Phila Pa 1976) 36 : E340-E344, 2011 https://doi.org/10.1097/BRS.0b013e3182015712
  6. Hassanzadeh H, Jain A, El Dafrawy MH, Ain MC, Mesfin A, Skolasky RL, et al. : Three-column osteotomies in the treatment of spinal deformity in adult patients 60 years old and older: outcome and complications. Spine (Phila Pa 1976) 38 : 726-731, 2013 https://doi.org/10.1097/BRS.0b013e31827c2415
  7. Herbert JJ : Vertebral osteotomy; technique, indications and results. J Bone Joint Surg Am 30 : 680-689, 1948 https://doi.org/10.2106/00004623-194830030-00015
  8. Hyun SJ, Lee BH, Park JH, Kim KJ, Jahng TA, Kim HJ : Proximal junctional kyphosis and proximal junctional failure following adult spinal deformity surgery. Korean J Spine 14 : 126-132, 2017 https://doi.org/10.14245/kjs.2017.14.4.126
  9. Hyun SJ, Lenke LG, Kim YC, Koester LA, Blanke KM : Comparison of standard 2-rod constructs to multiple-rod constructs for fixation across 3-column spinal osteotomies. Spine (Phila Pa 1976) 39 : 1899-1904, 2014 https://doi.org/10.1097/BRS.0000000000000556
  10. Kim SS, Cho BC, Kim JH, Lim DJ, Park JY, Lee BJ, et al. : Complications of posterior vertebral resection for spinal deformity. Asian Spine J 6 : 257-265, 2012 https://doi.org/10.4184/asj.2012.6.4.257
  11. Kim YJ, Hyun SJ, Cheh G, Cho SK, Rhim SC : Decision making algorithm for adult spinal deformity surgery. J Korean Neurosurg Soc 59 : 327-333, 2016 https://doi.org/10.3340/jkns.2016.59.4.327
  12. Leatherman KD, Dickson RA : Two-stage corrective surgery for congenital deformities of the spine. J Bone Joint Surg Br 61-B : 324-328, 1979 https://doi.org/10.1302/0301-620X.61B3.479255
  13. Lee BH, Hyun SJ, Kim KJ, Jahng TA, Kim YJ, Kim HJ : Clinical and radiological outcomes of posterior vertebral column resection for severe spinal deformities. J Korean Neurosurg Soc 61 : 251-257, 2018 https://doi.org/10.3340/jkns.2017.0181
  14. Lee BH, Hyun SJ, Park JH, Kim KJ : Single stage posterior approach for total resection of presacral giant schwannoma: a technical case report. Korean J Spine 14 : 89-92, 2017 https://doi.org/10.14245/kjs.2017.14.3.89
  15. Lenke LG, Newton PO, Sucato DJ, Shufflebarger HL, Emans JB, Sponseller PD, et al. : Complications after 147 consecutive vertebral column resections for severe pediatric spinal deformity: a multicenter analysis. Spine (Phila Pa 1976) 38 : 119-132, 2013 https://doi.org/10.1097/BRS.0b013e318269fab1
  16. Lewis ND, Keshen SG, Lenke LG, Zywiel MG, Skaggs DL, Dear TE, et al. : The deformity angular ratio: does it correlate with high-risk cases for potential spinal cord monitoring alerts in pediatric 3-column thoracic spinal deformity corrective surgery? Spine (Phila Pa 1976) 40 : E879-E885, 2015 https://doi.org/10.1097/BRS.0000000000000984
  17. Makhni MC, Shillingford JN, Laratta JL, Hyun SJ, Kim YJ : Restoration of sagittal balance in spinal deformity surgery. J Korean Neurosurg Soc 61 : 167-179, 2018 https://doi.org/10.3340/jkns.2017.0404.013
  18. Park YS, Hyun SJ, Kim KJ, Jahng TA : Multiple intradural disc herniations masquerading as intradural extramedullary tumors: a case report and review of the literature. Korean J Spine 13 : 30, 2016 https://doi.org/10.14245/kjs.2016.13.1.30
  19. Smith JS, Wang VY, Ames CP : Vertebral column resection for rigid spinal deformity. Neurosurgery 63 (3 Suppl) : A177-A182, 2008 https://doi.org/10.1227/01.NEU.0000320429.32113.85
  20. Suk SI, Chung ER, Kim JH, Kim SS, Lee JS, Choi WK : Posterior vertebral column resection for severe rigid scoliosis. Spine (Phila Pa 1976) 30 : 1682-1687, 2005 https://doi.org/10.1097/01.brs.0000170590.21071.c1
  21. Suk SI, Kim JH, Kim WJ, Lee SM, Chung ER, Nah KH : Posterior vertebral column resection for severe spinal deformities. Spine (Phila Pa 1976) 27 : 2374-2382, 2002 https://doi.org/10.1097/00007632-200211010-00012
  22. Wang H, Guo J, Wang S, Yang Y, Zhang Y, Qiu G, et al. : Instrumentation failure after posterior vertebral column resection in adult spinal deformity. Spine (Phila Pa 1976) 42 : 471-478, 2017 https://doi.org/10.1097/BRS.0000000000001844
  23. Wang XB, Lenke LG, Thuet E, Blanke K, Koester LA, Roth M : Deformity angular ratio describes the severity of spinal deformity and predicts the risk of neurologic deficit in posterior vertebral column resection surgery. Spine (Phila Pa 1976) 41 : 1447-1455, 2016 https://doi.org/10.1097/BRS.0000000000001547
  24. Wang Y, Xie J, Zhao Z, Zhang Y, Li T, Bi N, et al. : Perioperative major non-neurological complications in 105 patients undergoing posterior vertebral column resection procedures for severe rigid deformities. Spine (Phila Pa 1976) 40 : 1289-1296, 2015 https://doi.org/10.1097/BRS.0000000000000995
  25. Xie J, Wang Y, Zhao Z, Zhang Y, Si Y, Li T, et al. : Posterior vertebral column resection for correction of rigid spinal deformity curves greater than $100^{\circ}$. J Neurosurg Spine 17 : 540-551, 2012 https://doi.org/10.3171/2012.9.SPINE111026
  26. Zhang BB, Zhang T, Tao HR, Wu TL, Duan CG, Yang WZ, et al. : Neurological complications of thoracic posterior vertebral column resection for severe congenital spinal deformities. Eur Spine J 26 : 1871-1877, 2017 https://doi.org/10.1007/s00586-017-5061-3

피인용 문헌

  1. Kyphectomy and interbody fixation using lag screws in a child with myelomeningocele kyphosis: a technical case report vol.35, pp.8, 2019, https://doi.org/10.1007/s00381-019-04217-w