Abstract

Introduction: Rigid lordoscoliosis is uncommon and challenging to treat. Patients can develop respiratory impairment as well as sagittal and coronal imbalance, leading to low health-related quality of life. The surgical management of this type of deformity is not well defined in literature. We describe a new technique we call “Reverse Vertebral Column Decancellation” (RVCD) for the treatment of rigid hyper lordosis.
Methods: Case report of a 15-year-old female patient diagnosed with early-onset scoliosis, who had undergone several surgical procedures, developing a rigid lordotic deformity. The preoperative radiographic findings were a thoracic hyper lordosis (-7.3°) with positive sagittal imbalance with a sagittal vertical axis (+29.5 mm) and a negative Pelvic Tilt (PT) of -39°. Surgical treatment using the RVCD technique was chosen. RVCD entails complete resection of the posterior elements followed by a horizontal linear osteotomy of the posterior half of the vertebral body and a wedge decancellation of the anterior base of the lateral and anterior cortical bone of the latter, resulting in a Y-shaped osteotomy. Anterior closure is performed by posterior distraction to increase kyphosis.
Results: The patient had a postoperative correction of 51.5°, resulting in a thoracic kyphosis of +44.2°. There was a change in PI (pre: 19.7°, post: 14.4°) and a reduced but persistent negative pelvic tilt (-35.6°). Computed tomography scan six months after the procedure showed bone fusion. No neurological and infectious complications were reported during three years of follow-up.
Conclusion: The RVCD proved to be an effective and safe option for the treatment of rigid hyperlordotic deformity.

Keywords: Hyper lordosis; Lordoscoliosis; Spinal osteotomies; Vertebral column decancellation