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Huizhong Tian · Yuan Ma Jingming Xie · Yingsong Wang Editors
Spinal Osteotomy Orthopaedics
Deformity Correction
123
Spinal Osteotomy Orthopaedics
Editors
Spinal Osteotomy Orthopaedics
Deformity Correction
Editors
Huizhong Tian Spinal Surgery The Sixth Afliated Hospital of Xinjiang Medical University Urumqi, China
Yuan Ma Spinal Surgery The Sixth Afliated Hospital of Xinjiang Medical University Urumqi, China
Jingming Xie Department of Orthopedics The 2nd Afliated Hospital of Kunming Medical University Kunming, China
Associate Editors
Shaoyu Liu Department of Orthopedics The seventh Afliated Hospital of Sun Yat-sen University Shenzhen, China
Yijiang Liang Spine Surgery Afliated Hospital of Southwest Jiaotong University Chengdu, China
Zhi Zhao Department of Orthopedics The 2nd Afliated Hospital of Kunming Medical University Kunming, China
Yilihamu Tuoheti Department of Orthopedics The Seventh Afliated Hospital of Xinjiang Medical University Urumqi, China
Yingsong Wang Department of Orthopedics The 2nd Afliated Hospital of Kunming Medical University Kunming, China
Weibin Sheng Spine Surgery The First Afliated Hospital of Xinjiang Medical University Urumqi, China
Ying Zhang Department of Orthopedics The 2nd Afliated Hospital of Kunming Medical University Kunming, China
Tao Li Department of Orthopedics The 2nd Afliated Hospital of Kunming Medical University Kunming, China
Jiangtao Sui Spine Surgery The Sixth Afliated Hospital of Xinjiang Medical University Urumqi, China
Junjie Chen Department of Orthopedics Zhongshan People’s Hospital Zhongshan, China
Xia Lv Spine Surgery The Sixth Afliated Hospital of Xinjiang Medical University Urumqi, China
ISBN 978-981-16-1386-9 ISBN 978-981-16-1387-6 (eBook)
https://doi.org/10.1007/978-981-16-1387-6
Jointly published with Guangdong Science & Technology Press Co., Ltd
© Guangdong Science & Technology Press Co., Ltd 2021 This work is subject to copyright. All rights are reserved by the Publishers, whether the whole or part of the material is concerned, specically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microlms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specic statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publishers, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publishers nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publishers remain neutral with regard to jurisdictional claims in published maps and institutional afliations.
This Springer imprint is published by the registered company Springer Nature Singapore Pte Ltd. The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore

Foreword

Spinal Osteotomy for Deformity Correction is a monograph on the research and introduction of spinal osteotomy. The content is focused and comprehensive, and the layout is unique. The expression and narration combined with graphics and text is concise, intuitive, and vivid. This monograph meets the current clinical practice needs, with reference value and teaching signicance.
The publication of Spinal Osteotomy Orthopaedics further promotes osteotomy and ortho­pedics, further expands the scope of the treatment of osteotomy combined with internal xa­tion with instrumentation, and solves the problems that were difcult for treatment merely by instrumentation in the past. It has been further accepted by spine surgeons in the clinical appli­cation of spinal osteotomy in correcting spinal deformity. In recent years, various methods of spinal osteotomy have been reported and applied clinically, to name just a few, curetting (decancelous or eggshell surgery) or with a burr. However, still the use of a thin-blade osteo­tome for osteotomy is in the minority. As circular osteotomy surrounding the dural tube with thin- blade osteotome is technically demanding, this is a basic skill to be acquired by special training and long-term practice. This book Spinal Osteotomy for Deformity Correction is a tutorial for the young surgeons to master the thin-blade osteotome for spinal osteotomy.
This book emphasizes the importance of traction, osteotomy, and instrument correction for children’s spinal curvature during development. After this golden age, it will bring difculties to the correction of spinal deformity. It provides surgical strategies for congenital spine defor­mity, preventive osteotomy, and maneuver deformity correction.
A good book should be a handy tool dedicated to the reader. I believe that readers will ben­et from it, and improve the ability toward a high grade of spinal osteotomy.
2016.3.10
ShibiLu
Academician of the Chinese Academy of Engineering
Beijing, China
Beijing PLA General Hospital
Beijing, China
v

Foreword

In cases of ankylosing spondylitis kyphosis, spinal osteotomy is the only treatment, and it is impossible to correct this spinal deformity without osteotomy. Therefore, spinal osteotomy started from ankylosing spondylitis kyphosis. Spinal osteotomy was gradually applied to spi­nal curvature deformities due to other causes in the early 1980s. Spinal deformities such as congenital spinal deformity, idiopathic scoliosis, tuberculosis kyphosis, traumatic kyphosis, and degenerative scoliosis were corrected with spinal osteotomy combined with instrumenta­tion, obtaining a better therapeutic effect than the conventional treatment by instrumentation only for correcting spinal deformity.
Tian Huizhong and his team started this work earlier in China. On the basis of treating kyphosis deformity of ankylosing spondylitis, they gradually developed the application of osteotomy for the treatment of spinal deformities caused by other causes. They designed and made the Tian’s spine osteotome through the accumulation of a large number of clinical cases. They held the Tian’s osteotome courses in China and Japan several times and trained a large number of young doctors using the Tian’s spine osteotome for osteotomy, because the use of a thin-edged osteotome for osteotomy is a specialized technique that requires special training and long-term practice. The book of Spinal Osteotomy for Deformity Correction is a handy tool dedicated to readers. You will nd the book a great help. You will understand tacitly and grasp the essentials of the operation with a thin-blade osteotome.
JohnChi-YanLeong
2016.3.18
Academician of Chinese Academy of Sciences
Beijing, China
Open University of Hong Kong
Ho Man Tin, Hong Kong
vii

Original Introduction in Chinese Version

Smith Petersen (1945) was the rst person to perform spinal osteotomy for ankylosing spondylitis kyphosis (ASK). He began to use laminectomy plus manipulation to correct ankylosing kyphosis. Meanwhile, Smith Petersen named simple laminectomy as “spinal osteotomy.” Professor Tian Huizhong performed the rst case of ASK osteotomy at the Xinjiang Institute of Spinal Surgery in 1961, which is the earliest case of spinal osteotomy in China. Since then, we have entered into the era of treating ASK with simple laminectomy. But our method is different from Smith Petersen’s. We retain spinous process and lamina and use thin-blade osteotomy for osteotomy. The second part of this book rst introduces various osteotomy correction techniques for kyphosis deformity of ASK (funded by the National Natural Science Foundation of China, project number 81360280). Spinal osteotomy is the only way to treat ankylosing spondylitis hump (ASK). Unfortunately, there is no alternative.
The internal xation technology for scoliosis correction with simple instruments has developed rapidly, which has improved the treatment standard of spinal surgery and solved most cases in younger age groups with smaller curvature and better compliance since Harrington instruments were developed in the 1960s. However, it is difcult for rigid and structural severe scoliosis to be corrected by only instrumentation such as pedicle screw and rod system. Even the best quality instrumentation can hardly overcome the deforming force of scoliosis. In the end, the screw will be pulled out and the rod will be broken. This is the failure of correction as well as the source of complication. How to eliminate the deforming force of curved spine? Osteotomy is the best way to eliminate the deforming force of curved spine and lift the load of instrumentation. Therefore, the combination of spinal osteotomy and instrumentation is the best choice for the treatment of spinal deformity.
This book helps the readers when they nd treating cases just with instrumentation is difcult and cases of early-onset deformity requiring osteotomy. It is only a remedy for the deciency of instrumentation. Through clinical application and continuous summary of experience, the surgical methods of instrumentation and treatment scope of spinal osteotomy are expanding. Treating deformity with osteotomy and instrumentation has got the recognition of most colleagues, especially for children who are still developing. My team and I were preparing to write Spinal Osteotomy for Deformity Correction to share our clinical experience with most of our colleagues and promote the development of spinal surgery 2 years ago.
This book is a reference for colleagues. It is a continuation based on the style of osteotomy and publication in the past 50 years while trying to illustrate with operation photos and typical cases. We did our best to produce the anatomical and radiographic pictures involved. At the same time, three-dimensional technology and digital medicine and simulation medicine are introduced to explain the operation process, so that readers can get familiarized with the relevant anatomy of the spine, and establish a good mindset to master the operation technique.
This book emphasizes the importance of traction, osteotomy, and instrumentation for spinal deformity in children who are growing and developing. After the golden age, it will bring difculties to the correction of the spinal deformity. It puts forward the surgical strategies for congenital curvature of the spine, preventive early osteotomy, and correction of the deformity of the spine.
ix
x
Original Introduction in Chinese Version
The contents of Spinal Osteotomy for Deformity Correction are divided into 4 parts and 53 chapters. The rst part is a general introduction, which mainly describes the history of spinal osteotomy correction, spinal anatomy, biomechanics, clinical examination and diagnosis, simulation technology, postoperative external xation, treatment of complications, and the application of the spine osteotome. The second part is the osteotomy correction for ASK.Various osteotomy techniques of ASK are described in detail with the combination of graphics and texts. The third part is about the osteotomy correction of spinal deformity for other etiologies, such as congenital, tuberculous, traumatic, degenerative, juvenile, and idiopathic tumors. The fourth part is about other conditions operated with osteotomes, such as discectomy, spinal canal decompression, anterior decompression of spinal cord grooving decompression with osteotome, and so on.
This book is practical, novel, and full of pictures and texts, containing more than 1700 high­denition pictures which shows techniques and steps of each osteotomy with graphics, so as to enable beginners to master surgical techniques quickly. References are attached at the end of each chapter for the reader’s reference.
Thank you very much for the help and support of colleagues and experts in the process of compiling this book. Special thanks to Academician ShibiLu and John Chi-Yan Leong for their guidance and review despite their busy schedules, which makes this book perfect. Our thanks also go to the Sixth Afliated Hospital of Xinjiang Medical University and the Second Afliated Hospital of Kunming Medical University for the support and encouragement. We also thank Liang Zhou, Vice-President of Guangdong Science and Technology Publishing House, for his planning and guidance despite his busy schedule, so that the book can be brought to readers at an early date.
Due to the restriction of time and limitation of the author, this book might still contain unavoidable errors. We ask for criticism and correction by readers. The illustrations cited are listed in the references in the compilation of this book. As for any missing information please contact the authors of this book.
HuizhongTian
2016-3-27 YuanMa
JingmingXie

Introduction

Spinal Osteotomy for Deformity Correction is a monograph of introducing osteotomy for spi­nal deformity correction surgery. Its content is prominent and comprehensive. The unique arrangement with the combination of pictures and text is concise, intuitive, and vivid. It is a monograph for the needs of current clinical practice with reference value and teaching signi­cance. The publication of Spinal Osteotomy for Deformity Correction expands the scope of application of osteotomy and the combined treatment with osteotomy and internal xation. It solves the difcult problems treated only by simple instruments in the past and made spinal osteotomy further recognized by spinal surgeons in clinical application.
The Chinese version of Spinal Osteotomy for Deformity Correction was published by Guangdong Science and Technology Press in October 2018, including 4 articles and 53 chap­ters. The English version of Spinal Osteotomy for Deformity Correction was published by Springer, which is published in two volumes. The rst volume is on spinal deformity osteot­omy which consists of 13 chapters, including “History of the Development of Spinal Osteotomy,” “Application of Tian’s Spinal Osteotomes,” “Transverse Laminectomy for Ankylosing Spondylitis Kyphosis,” “V-Shape Laminectomy for Ankylosing Kyphosis,” “Pedicle Subtraction Osteotomy for Ankylosing Kyphosis Deformity,” “Vertebral Column Resection for Ankylosing Spondylitis Kyphosis,” “Non-apex Osteotomy for ASK,” “Apex Osteotomy for AS Kyphosis,” “Spinal Osteotomy for Congenital Angular Kyphosis,” “Hemivertebra Osteotomy,” “Osteotomy for Tuberculosis Angular Kyphosis,” “Posterior Vertebral Column Resection (PVCR) Correction for Severe Rigid Spinal Deformity,” and “Osteotomy for Traumatic Spinal Deformity.” They are various surgical methods of spinal osteotomy with Tian’s osteotomes and also described in detail by pictures and text.
The feature of this book is to illustrate the method of surgical operation to achieve the pur­pose of enabling beginners to quickly grasp the surgical skills. A good book is a set of handy tools dedicated to the reader. We believe that readers will benet from it and improve the abil­ity and application level of spinal osteotomy and surgery.
We would like to express our deep appreciation to all the colleagues and experts for their great assistance and support in the translation and editing of this book! Thanks to the Sixth Afliated Hospital of Xinjiang Medical University and the Second Afliated Hospital of Kunming Medical University for their strong support and encouragement! Thanks to Zhou Liang, vice president, and Zeng Chong, editor of Guangdong Science and Technology Press, for your support! We would also like to thank Hu Bin, editor of Springer Press, and Jiao Guohui, editor of Springer, for taking time out of your busy schedules to plan and guide the book, so that it can be brought to the readers as soon as possible.
HuizhongTian
2020-11-25 YuanMa
JingmingXie YingsongWang
xi

Contents

1 History of the Development of Spinal Osteotomy . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Huizhong Tian, Yuan Ma, Jingming Xie, Yingsong Wang, and Xia Lv
2 Application of Tian’s Spinal Osteotomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Huizhong Tian, Yuan Ma, and Xia Lv
3 Transverse Laminectomy for Ankylosing Spondylitis Kyphosis . . . . . . . . . . . . . . 21
Huizhong Tian, Jiangtao Sui, and Ying Zhang
4 V-Shape Laminectomy for Ankylosing Kyphosis . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Huizhong Tian, Zhi Zhao, and Ni Bi
5 Pedicle Subtraction Osteotomy for Ankylosing Kyphosis Deformity . . . . . . . . . . . 47
Huizhong Tian, Tao Li, and Zhibo Song
6 Vertebral Column Resection for Ankylosing Spondylitis Kyphosis . . . . . . . . . . . . 57
Huizhong Tian, Yuan Ma, and Jingming Xie
7 Non-apex Osteotomy for ASK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
Yingsong Wang, Ying Zhang, and Huizhong Tian
8 Apex Osteotomy for AS Kyphosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Yijian Liang, Shaoyu Liu, Huizhong Tian, and Junyi Ma
9 Spinal Osteotomy for Congenital Angular Kyphosis . . . . . . . . . . . . . . . . . . . . . . . . 107
Huizhong Tian, Weibin Sheng, Yilihamu Tuoheti, Li Li, and Junyi Ma
10 Hemivertebra Osteotomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
Huizhong Tian, Junjie Cheng, Tao Li, Zhibo Song, Zhiyue Shi, Zhi Zhao, Xu Zhu, Jie Dai, Junyi Ma, Jiangtao Sui, Weibin Sheng, Shaoyu Liu, and Quan Li
11 Osteotomy for Tuberculosis Angular Kyphosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
Huizhong Tian, Sikandaer Siyiti, Quan Li, Zhiyue Shi, Jie Dai, Xu Zhu, Yingsong Wang, Ni Bi, and Li Li
12 Posterior Vertebral Column Resection (PVCR) Correction
for Severe Rigid Spinal Deformity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
Jingming Xie
13 Osteotomy for Traumatic Spinal Deformity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
Huizhong Tian, Yuan Ma, Yingsong Wang, and Li Li
xiii