Congenital Cervico-thoracic Scoliosis: New Trends of Surgical Management

Abstract

Introduction: Congenital cervico-thoracic scoliosis is a rare disorder with challenging surgical management. There are several surgical options but three column osteotomies with the use of hemivertebra arc as a bearing point for correction has not been evaluated. The aim is to evaluate the correction of congenital cervico-thoracic junction with the use of three-column osteotomies and the use of hemivertebra arc as a bearing point for correction. Methods: Eleven patients aged 2 to 12 years who had surgery between 2014 and 2018 were evaluated. The criteria used include the type of defect, the principal defect in multiple anomalies, the angle of scoliotic deformation before, after surgery and at follow-up, motor evoked potentials, Frenkel scale, age, blood loss, operation time and complications. They were followed up for 1 – 5 years. Student’s t-test was used with P<0.05 considered significant. Results: There were no local and global balance disorders. Scoliotic arc averaged 41.9±10.7 before surgery, 11.8±9.9° after surgery (p<0.001) with average correction of 73.8±15.6% (p<0.001). The deviation from the CSVL line had 61.4±37.7% correction (P=0.007). All the patients had full frontal balance recovery due to self-correction. Intra-operative neuromonitoring was M-answers in the patients monitored. They all had pre-surgery Frankel gradings and also at follow up. Five had complications that resolved. Discussion: There was reduction in number of fixed cranial segments, flexibility of cervical spine, good correction and avoidance of neurological complications.