[One stage three-column osteotomy for the treatment of scoliosis with split spinal cord malformation]

To analyze the effectiveness and safety of one stage three column osteotomy in treatment of scoliosis with split spinal cord malformation.

The clinical data of 41 patients with scoliosis and split spinal cord malformation underwent one-stage three-column osteotomy from January 2015 to December 2017 were retrospectively analyzed. There were 17 males and 24 females with average age of (25.14±4.51) years old and the average weight of (65.14±9.11) kg. According to the classification of longitudinal spina bifida, 15 cases of Pang typeⅠwere group A and 26 cases of Pang typeⅡwere group B. The general situations of two groups were recorded ; preoperative and postoperative Cobb angle were observed and the correction rate of Cobb angle of coronal plane was calculated ; the coronal and sagittal torso offset distances were compared between two groups and the trunk balance was evaluated ; the complication of two groups was recorded.

All 41 patients were followed up for more than 12 months. The operation time, intraoperative blood loss, and perioperative blood transfusion volume in group A were (610.14±115.02) min, (4 001.12±1 014.33) ml, (3 951.14±1 021.55) ml, respectively, and group B were (520.12±101.14) min, (2 701.57±1 021.45) ml, (2 565.77±880.47) ml, the difference between the two groups was statistically significant (P<0.05). The postoperative hospital stays in the group A and B were (9.45±4.21) days and (9.14±3.01) days, respectively, and there was no significant difference (P>0.05). There was no significant difference in postoperative coronary Cobb angle and correction rate between two groups (P>0.05). Immediately after surgery and 12 months after surgery, there was no significant difference in the trunk displacement distance of coronal view and sagittal view between two groups (P>0.05). Six patients in group A had complications, which was higher than that in group B of 1 case (χ²=4.885, P< 0.05).

One-stage three-column osteotomy in treatment of scoliosis with split spinal cord malformation has high correction rate and good balance of the trunk. However, for patients with typeⅠsplit spinal cord malformation, they will face longer operation time, more intraoperative bleeding volume, large amount of perioperative blood transfusion and higher risk of complications, and the safety is not as good as that of typeⅡpatients. Therefore, in the actual treatment of scoliosis, especially for those with typeⅠsplit spinal cord malformation, a more reasonable surgical plan should be developed in combination with the actual situations of the patients, so as to improve the safety of the operation.