Authors: Mirzashahi Babak, Malekzadeh Maziar, Saied Besharaty.
Background: Achondroplasia is the most common cause of skeletal dysplasia and thoracolumbar kyphosis is one of the most common spinal disorders in achondroplastic patients. If the thoracolumbar kyphosis progresses despite conservative treatment, or if the kyphosis exceeds 50 degrees, or patients develop neurological deficits relating to the thoracolumbar kyphosis, surgical intervention is indicated. Currently there are several surgical techniques for correction of thoracolumbar kyphosis, such as pedicle subtraction osteotomy (PSO) and vertebral column resection (VCR) but there are few reports about using Vertebral Column Decancellation (VCD), especially in skeletally mature achondroplastic patients. The purpose of this study is to evaluate the results and complications and outcome of Vertebral Column Decancellation (VCD) in a skeletally mature achondroplastic patient.
Case Presentation: A 34 years old achondroplastic man with severe thoracolumbar kyphosis (103 degree) and significant neurological symptoms such as bilateral lower limbs numbness and claudication underwent Vertebral Column Decancellation (VCD). The patient was evaluated radiographically and clinically for 2 years with SRS22 Score and ODI Score and VAS Score. The patient responded very well to VCD. The neurological symptoms improved and deformity was corrected with minimal surgical complications.
Conclusions: The long term radiological and clinical results of Vertebral Column Decancellation (VCD) in treatment of sharp angular thoracolumbar kyphosis in achondroplastic mature patient demonstrated that this technique is a relatively safe procedure and also has favorable outcomes. Since surgical complications are the major concerns about 3-column osteotomies, strict adherence to agreed surgical protocols can minimize the rates of complications (such as dural rupture, surgical site infection, massive bleeding). With meticulous hemostasis and administration of tranexamic acid during the surgery the rate of blood loss can be reduced. Despite the impaired enchondral ossification in achondroplastic patients, due to the bone-to-bone contact in VCD, the risks of nonunion and subsequent complication such as rod breakage can be reduced.
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