Operative technique
For kyphosis
- Initial Approach:
- Midline skin incision and subperiosteal dissection
- Pedicle screws inserted using free-hand technique
- VCD Procedure:
- Probe pedicle of deformed vertebral body
- Use C-arm fluoroscopy for guidance
- Enlarge pedicle hole with high-speed drill
- Remove cartilaginous endplates and thin vertebral walls
- Resect posterior wall
- Create "bony cage" from residual cancellous bone
- Correction Process:
- Remove posterior elements (spinous processes, laminae, etc.)
- Perform osteoclasis through manual extension
- Create anterior opening wedge
- Position hinge at anterior-medial column border
- Final Steps:
- Add autogenous bone if needed for large gaps
- Confirm correction with fluoroscopy
- Apply final internal fixation
For kyphoscoliosis
- Basic techniques similar to kyphosis correction.
- Correction considered in both coronal and sagittal planes.
- Decancellation mainly on the convex side.
- Convexity of the spine was closed.
- Segmental compression was achieved.
- Autograft bone chips implanted in residual intervertebral spaces after internal fixation.
- In cases with multilevel posterior structure removal and inability to close the gap with rods:
- Iliac bone harvested as matchsticks.
- Matchsticks implanted into the posterior space and/or placed over transverse processes.
Postoperative management
- Closed suction drains were inserted at the resection site in all patients.
- Drains were discontinued when blood collection was <50 ml per 24 h.
- All patients were extubated immediately after the procedure.
- Patients were typically allowed to ambulate within 48–72 h using a thoracolumbosacral orthosis, which was worn thereafter with ambulation for 3 months.
Made with Bullet