Clinical and radiologic outcomes of posterior column extension, pedicle subtraction, and vertebral column resection osteotomies in adult chin on chest deformity: A systematic review

Ergin Coskun; Ian J Wellington; Chirag Chaudhary; Kathleen Crea; Mark P Cote; John M Rhee; Scott Mallozzi; Isaac L Moss; Hardeep Singh

doi:10.1016/j.xnsj.2024.100324

Clinical and radiologic outcomes of posterior column extension, pedicle subtraction, and vertebral column resection osteotomies in adult chin on chest deformity: A systematic review

N Am Spine Soc J. 2024 Apr 12:18:100324. doi: 10.1016/j.xnsj.2024.100324. eCollection 2024 Jun.

Authors

Ergin Coskun¹, Ian J Wellington², Chirag Chaudhary³, Kathleen Crea⁴, Mark P Cote⁵, John M Rhee⁶, Scott Mallozzi², Isaac L Moss², Hardeep Singh²

Affiliations

¹ Riley Hospital for Children, Indiana University Health, 705 Riley Hospital Dr, Indianapolis, IN 46202, United States.
² Department of Orthopedics, The University of Connecticut, 120 Dowling Way, Farmington, CT 06032, United States.
³ Insight Surgical Hospital, 21230 Dequindre Rd Warren, MI 4809, United States.
⁴ Lyman Maynard Stowe Library, UConn Health, The University of Connecticut, 120 Dowling Way, Farmington, CT 06032, United States.
⁵ Massachusetts General Brigham Sports Medicine, Harvard Medical School, The University of Connecticut, 120 Dowling Way, Farmington, CT 06032, United States.
⁶ Department of Orthopedic Surgery, Emory Spine Center, Emory University, 59 Executive Park South, Atlanta, GA 30327, United States.

Abstract

Background: Chin-on-chest deformity is a rare and severely disabling condition characterized by kyphotic deformity in the cervicothoracic spine. To treat this deformity, various osteotomy techniques were described.

Methods: A comprehensive literature search of biomedical databases including MEDLINE (via PubMed), Scopus (via Elsevier), Embase (via Elsevier), and Cochrane Library in English from 1/1/1990 to 3/31/2022 was conducted using a combination of text and Medical Subject Headings (MeSH).

Results: The final analysis included 16 studies. All the studies were assigned a level of evidence of four. Except for two articles, all of the articles were non-comparative studies. A total of 288 patients were included in this review. Of the 288 patients, 107 underwent posterior column extension osteotomy (PCEO), 108 underwent pedicle subtraction osteotomy (PSO), and 33 underwent vertebral column resection osteotomy (VCRO). The most common osteotomy level in fifteen of the studies was C7/T1. The studies included in this review described several techniques for cervical sagittal balance correction. The range of preoperative and postoperative visual analogue scale (VAS) scores was 5.5-8.6 to 1.7-4.91, respectively. The range of preoperative and postoperative neck disability index (NDI) was 34.2-65.4 to 22.1-51.3, respectively. The most common complications were upper extremity paresthesia and hand numbness through the C8 dermatome distribution.

Conclusions: Corrective osteotomies provide satisfactory results in patients with chin-on-chest deformity; however, the quality of the included studies limits the evidence.

Keywords: Cervico-thoracic osteotomies; Chin-on-chest deformity; Kyphosis; Pedicle subtraction osteotomy; Posterior column extension osteotomy; Vertebral column resection osteotomy.

Publication types

Review