Comparison of pedicle subtraction osteotomy and vertebral column resection in adolescent congenital kyphoscoliosis and the influencing factors on intraoperative hemorrhage: a retrospective study.

Abstract

Objective: To explore the efficacy of different methods of osteotomy in the treatment of severe Winter type I adolescent congenital kyphoscoliosis (CKS) and to analyze the influencing factors of massive intraoperative hemorrhage in these patients.

Methods: A retrospective analysis was conducted on the clinical data of 47 patients with severe CKS admitted to our hospital from October 2016 to December 2022. According to different surgical methods, they were divided into a PSO group and a VCR group. All patients in the PSO group were treated with multi-segment pedicle subtraction osteotomy (PSO), n=24. All patients in the VCR group were treated with single-segment vertebral column resection (VCR), n=23. The surgical status (including operation time, intraoperative blood loss, and days of hospitalization), surgical correction situation (including coronal Cobb angle, global kyphosis (GK), visual analogue scale (VAS) score, and Oswestry disability index (ODI)), and the occurrence of complications were analyzed and compared between the two groups of patients. The occurrence of massive intraoperative bleeding in patients was assessed, and a multivariate Logistic analysis was performed to identify the independent influencing factors of massive intraoperative hemorrhage in all patients.

Results: The operation time of the PSO group was longer than that of the VCR group (P<0.05). No statistical differences were found in the comparison of coronal Cobb angle, GK, VAS score and ODI score between the PSO group and the VCR group before surgery (all P>0.05). After surgery, the coronal Cobb angle, GK, VAS score, and ODI score of patients in both groups were significantly improved compared with those before surgery (all P<0.05). Moreover, the improvements in coronal Cobb angle, GK and ODI score in the PSO group were more significant than those in the VCR group (all P<0.05). All patients were followed up for more than 18 months. During the follow-up period, the incidence of complications in the VCR group was higher than that in the PSO group, but with no statistically significant difference (P>0.05). According to the occurrence of massive intraoperative hemorrhage, the patients were divided into a hemorrhage group (n=19) and a normal group (n=28). Univariate analysis showed that there were statistically significant differences in the number of fixed segments, the osteotomy site, ESR, coronal Cobb angle, GK and the number of osteotomy segments between the hemorrhage group and the normal group (all P<0.05). The results of multivariate logistic regression analysis showed that the number of fixed segments, osteotomy site, coronal Cobb angle, and the number of osteotomy segments were independent influencing factors for massive intraoperative hemorrhage in patients with CKS.

Conclusion: Both multi-segment PSO and VCR have good correction outcomes on CKS. In comparison, although multi-segment PSO has a longer operation time, its correction outcomes are better than that of VCR, and it does not significantly increase the risk of surgical complications. In addition, the number of fixed segments, osteotomy site, coronal Cobb angle, and the number of osteotomy segments are independent influencing factors for massive intraoperative hemorrhage.