Artikel
The change of trunk shift and head tilt in congenital scoliosis of the cervicothoracic junction following short segmented surgery
Die Änderung in der Verkrümmung des Oberkörpers und der Kopfhaltung bei kongenitaler kinderlicher Skoliose im zervikothorakalen Übergang nach kurzstreckiger Aufrichtungsoperation
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Autoren
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Benedikt Burkhardt
- Universität des Saarlandes, Klinik für Neurochirurgie, Homburg-Saar, Deutschland
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Tobias Pitzen
- Universität des Saarlandes, Klinik für Neurochirurgie, Homburg-Saar, Deutschland
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Michael Ruf
- Universität des Saarlandes, Klinik für Neurochirurgie, Homburg-Saar, Deutschland
| Veröffentlicht: | 8. Mai 2019 |
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Gliederung
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Objective: Congenital scoliosis at the cervicothoracic junction is often accompanied by an oblique head position due to limited compensation possibilities of the upper cervical spine in the coronal plane. The purpose of this study was to assess the impact of head position on the overall coronal spinal balance and the effect of surgical correction.
Methods: A retrospective review of radiographic imaging and clinical outcome of 19 consecutive patients suffering from hemivertebral of the cervicothoracic junction was conducted. All patients underwent resection of the hemivertebra and short segmented correction and fixation. The following radiological parameters were measured: Cobb angle of the main and compensatory curves, head tilt in relation to horizon, and the trunk shift, defined as the angle between a line from the centre of C7 to the sacrum and the Central Sacral Vertical Line (CSVL). Clinical outcome parameters at final follow-up were also assessed.
Results: The mean radiographical and clinical follow-up was 8.5 years. The mean Cobb angle of the main curve was 43.8°, upper compensatory curve 13.7°, lower compensatory curve 28.3°. Head tilt was 6.7°, and trunk shift was 4.0°. The amount of head tilt correlated significantly with the amount of trunk shift to the convex side of the curve (p: 0.034, r: 0.443). Postoperatively the main curve was 11.8°, upper compensatory curve 6.6°, lower compensatory curve 12.1°. Head tilt was -0.3°, and trunk shift was 0.2°. Again, head tilt correlated significantly with trunk shift. Eight patients underwent revision procedure during the process of follow-up caused by decompensation of the lower curvature. Clinical outcome was excellent with respect to physical activity and pain levels in all patients.
Conclusion: Correction of the main curve had a significant impact on postoperative head tilt and trunk shift. The position of the head in the coronal plane appears to play a significant role in overall trunk balance. Failure to achieve a horizontal head position is followed by a compensatory trunk shift. Correction of the deformity with balancing of the head resulted in spontaneous correction of the trunk shift.
