Skip to main content

Advertisement

SpringerLink
Log in

Characterization of complex vertebral transposition (gamma deformity) > 180 degrees: clinical and radiographic outcomes of halo gravity traction and vertebral column resection (VCR)

  • Case Series
  • Published:
Spine Deformity Aims and scope Submit manuscript

Abstract

Study Design

Prospective case series

Objective

Results of surgical treatment of complex vertebral transposition “Gamma Deformity” > 180 degrees with halo gravity traction (HGT) and vertebral column resection (VCR).

Summary of background data

We recently published a novel classification system for complex spine deformities of which complex vertebral transposition > 180 degrees (Gamma; type 3) was described. Halo gravity traction (HGT) has been shown to mitigate surgical risk in complex spine deformity correction and in some cases obviates the need for three-column osteotomy. However, we are not aware of report of its utilization in treating Gamma deformities with or without vertebral column resection (VCR).

Methods

A consecutive series of 13 patients with Gamma deformity (GD) were prospectively enrolled at a single site in West Africa. Standard radiographs and 3D computerized tomography (CT) were done to assess coronal and sagittal vertebral transposition (CVT and SVT). The HGT with 50% of body weight was applied over several weeks followed by VCR. Demographics, operative data, radiographic parameters, and complications data were collected.

Results

13 pts with GD underwent HGT for an avg of 110 days prior to definitive surgery. Etiologies were Congenital—11 pts and Neurofibromatosis—2 pts. Average age: 17.8 years; Pts were reviewed at 3 months post-op and at minimum 2-year follow-up. Preop myelopathy was present in five patients. Pre-op CVT avg 75% and was corrected in all cases post-op. SVT avg 211 deg and improved with HGT by 36% and corrected to 53 deg (74% correction) post-op. Thoracic kyphosis avg -42 deg and averaged 48 deg post-op. Intra-op spinal cord monitoring (SCM) alerts occurred in 8 pts (61%). Post-operative LEM deficits occurred in 5 pts: 2 fully recovered by 3 months and 2 year follow-up, while the remaining 3 improved but had residual motor deficits at final follow-up. There was one post-operative mortality.

Conclusion

The management of complex vertebral transposition (Gamma deformity) > 180 degrees with HGT prior to VCR is not only effective in some patients, but also associated with high SCM alerts and neurologic injury rates. Myelopathic patients with thoracic deformities are at higher risk of developing permanent neurologic deficits. Surgeons should be aware of this rare and unusual deformity and consider HGT and VCR bearing in mind the technical challenges and high complication rate.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Smith JT, Gollogly S, Dunn HK (2005) Simultaneous anterior-posterior approach through a costotransversectomy for the treatment of congenital kyphosis and acquired kyphoscoliotic deformities. J Bone Joint Surg Am. 87(10):2281–91

    PubMed  Google Scholar 

  2. Ozturk C, Alanay A, Ganiyusufoglu K, Karadereler S, Ulusoy L, Hamzaoglu A (2012) Short-term X-ray results of posterior vertebral column resection in severe congenital kyphosis, scoliosis and kyphoscoliosis. Spine 37(12):1054–7

    Article  Google Scholar 

  3. Xie J, Wang Y, Zhao Z, Zhang Y, Si Y, Li T, Yang Z, Liu L (2012 Dec 1) Posterior vertebral column resection for correction of rigid spinal deformity curves greater than 100. J Neurosurg Spine 17(6):540–551

    Article  Google Scholar 

  4. Xie J, Wang Y, Zhao Z, Zhang Y, Si Y, Yang Z, Liu L, Lu N (2011) One-stage and posterior approach for correction of moderate to severe scoliosis in adolescents associated with chiari 1 malformation: is a prior suboccipital decompression always necessary? J Eur Spine 20(7):1106–2015

    Article  Google Scholar 

  5. Zhang Z, Wang H, Shangguan L (2013) Posterior 2-level vertebral column resection for the treatment of progressive rotational dislocation in kyphoscoliotic deformities. World Neurosurg. 88:428–32. https://doi.org/10.1016/j.wneu.2015.10.057

    Article  Google Scholar 

  6. Yang C, Zheng Z, Liu H, Wang J, Kim YJ, Cho S (2016) Posterior vertebral column resection in spinal deformity: a systematic review. Eur Spine J 25(8):2368–2375

    Article  Google Scholar 

  7. Lenke LG, Newton PO, Sucato DJ et al (2013) Complications after 147 consecutive vertrbral column resections for severe pediatric spinal deformity. Spine 30:119–132

    Article  Google Scholar 

  8. Auerbach JD, Lenke LG, Bridwell KH et al (2012) Major complications and comparison between 3-column osteotomy techniques in 105 consecutive spinal deformity procedures. Spine 37:1198–1210

    Article  Google Scholar 

  9. Rajasekaran S, Rishi MKP, Shetty AP (2011) Closing-opening wedge osteotomy for severe, rigid, thoracolumbar post-tubervular kyphosis. J Eur Spine 20(3):343–7

    Article  CAS  Google Scholar 

  10. Karikari IO, Pang H, Yankey KP, Duah HO, Akoto H, Hodes R, Boachie-Adjei O (2019) FOCOS Spine Research Group A novel radiographic classification of severe spinal curvatures exceeding 100: the Omega (Ω), gamma (γ) and alpha (α) deformities. Eur Spine J 3:1–2

    Google Scholar 

  11. Boachie-Adjei O, Yagi M, Nemani VM, Sacramento-Dominguez C, Akoto H, Cunningham ME, Gupta M, Hess WF, Lonner BS, Mendelow MJ, Papadopoulus EC (2015 Jan 1) Incidence and risk factors for major surgical complications in patients with complex spinal deformity: a report from an SRS GOP site. Spine Deform 3(1):57–64

    Article  Google Scholar 

  12. Nemani VM, Kim HJ, Bjerke-Kroll BT, Yagi M, Sacramento-Dominguez C, Akoto H, Papadopoulos EC, Sanchez-Perez-Grueso F, Pellise F, Nguyen JT, Wulff I (2015 Feb 1) Preoperative halo-gravity traction for severe spinal deformities at an SRS-GOP site in West Africa: protocols, complications, and results. Spine 40(3):153–161

    Article  Google Scholar 

  13. Anthony Rinella, Lawrence Lenke, Camden Whitaker (2005) More Preoperative Halo Gavity Traction in the treatment of severe scoliosis and kyphosis. Spine 30(4):475–482

    Article  Google Scholar 

  14. Iyer S, Boachie-Adjei O, Duah HO, Yankey KP, Mahmud R, Wulff I, Tutu HO, Akoto H (2019 ) Halo gravity traction can mitigate preoperative risk factors and early surgical complications in complex spine deformity. Spine 44(9):629–636

    Article  Google Scholar 

  15. Audigé L, Bhandari M, Hanson B, Kellam J (2005 Jul 1) A concept for the validation of fracture classifications. J Orthop Trauma 19(6):404–409

    Article  Google Scholar 

  16. Garbuz DS, Masri BA, Esdaile J, Duncan CP (2002) Classification systems in orthopaedics. J Am Acad Orthop Surg 10(4):290–7

    Article  Google Scholar 

  17. Demirkiran G, Dede O, Karadeniz E, Olgun D, Ayvaz M, Yazici M (2017) Anterior and posterior vertebral column resection versus posterior-only technique. Clin Spine Surg 30(7):285–290

    Article  Google Scholar 

  18. Lee BH, Hyun SJ, Kim KJ, Jahng TA, Kim YJ, Kim HJ (2018) Clinical and radiological outcomes of posterior vertebral column resection for severe spinal deformities. J Korean Neurosurg Soc 61(2):251

    Article  Google Scholar 

  19. Papadopoulos EC, Boachie-Adjei O, Hess WF, Perez-Grueso FJ, Pellisé F, Gupta M, Lonner B, Paonessa K, Faloon M, Cunningham ME, Kim HJ (2015 ) Early outcomes and complications of posterior vertebral column resection. Spine J 15(5):983–991

    Article  Google Scholar 

  20. Kawahara N, Tomita K, Baba H, Kobayashi T, Fujita T, Murakami H (2001 ) Closing–opening wedge osteotomy to correct angular kyphotic deformity by a single posterior approach. Spine 26(4):391–402

    Article  CAS  Google Scholar 

  21. Wang XB, Lenke LG, Thuet E, Blanke K, Koester LA, Roth M (2016 ) Deformity angular ratio describes the severity of spinal deformity and predicts the risk of neurologic deficit in posterior vertebral column resection surgery. Spine 41(18):1447–1455

    Article  Google Scholar 

  22. Wang S, Aikenmu K, Zhang J, Qiu G, Guo J, Zhang Y, Weng X (2017) The aim of this retrospective study is to evaluate the efficacy and safety of posterior-only vertebral column resection (PVCR) for the treatment of angular and isolated congenital kyphosis. Eur Spine J 26(7):1817–1825

    Article  Google Scholar 

Download references

Funding

The paper was funded with a grant from K2M (Grant No: K2M/FC/060216).

Author information

Authors and Affiliations

  1. FOCOS Orthopedic Hospital, No 8 Teshie Street, Pantang Accra, Ghana

    Oheneba Boachie-Adjei, Jennifer Ayamga, Arthur Sackeyfio, Henry Ofori Duah, Kwadwo Poku Yankey & Irene Wulff

  2. Centro de Tratamiento de Columna Vertebral CS, Madrid, Spain

    Cristina Sacramento-Dominguez

  3. Korle Bu Teaching Hospital, Accra, Ghana

    Harry Akoto

  4. American Jewish Joint Distribution Committee (JDC), Addis Ababa, Ethiopia

    Rick Hodes

  5. Vall D’Hebron University Hospital, Barcelona, Spain

    Ferran Pellise

Authors
  1. Oheneba Boachie-Adjei
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cristina Sacramento-Dominguez
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jennifer Ayamga
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Arthur Sackeyfio
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Henry Ofori Duah
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kwadwo Poku Yankey
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Harry Akoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Rick Hodes
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Irene Wulff
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Ferran Pellise
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

FOCOS Spine Research Group

Contributions

Conceptualization and Design: All authors. Data Collection: All authors. Data Cleaning and Preparation: Ayamga, Duah, Sackeyfio, Data Analysis and interpretation: Ayamga, Duah, Sackeyfio, Boachie-Adjei. Writing – Initial draft preparation: Ayamga, Sacramento, Pellise, Boachie-Adjei, Akoto, Wulff. Writing -Critical Review for important intellectual contentAll authors. Final Approval: All authors. Funding acquisition: Boachie-Adjei, Duah. Resources: Boachie-Adjei. Supervision: Boachie-Adjei, Pellise, Sacramento.

Corresponding author

Correspondence to Oheneba Boachie-Adjei.

Ethics declarations

Conflict of interest

Oheneba Boachie-Adjei (grants, personal fees and other from K2M, other from WEIGAO, outside the submitted work). For the remaining authors none were declared.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

IRB approval statement

The study was approved by the institutional review board (IRB) of the Noguchi Memorial Institute for Medical Research (NMIMR), College of Health Sciences, University of Ghana (Study Protocol Number: 045/15–16 revised in 2019).

Appendix A

Appendix A

See Fig. 8.

Fig. 8
figure 8

A brief protocol of the Traction and relation to Spinal Cord Monitoring (SCM) changes

Full size image

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Boachie-Adjei, O., Sacramento-Dominguez, C., Ayamga, J. et al. Characterization of complex vertebral transposition (gamma deformity) > 180 degrees: clinical and radiographic outcomes of halo gravity traction and vertebral column resection (VCR). Spine Deform 9, 411–425 (2021). https://doi.org/10.1007/s43390-020-00179-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s43390-020-00179-1

Keywords

Search

Navigation