La correzione di una gravissima cifosi di oltre 100 gradi mediante doppia vertebrectomia, in 3’

The simultaneous removal of two non-contiguous thoracic vertebrae was performed for the first time at the Rizzoli Hospital in Bologna to straighten the spine of a patient confined to a wheelchair due to severe kyphosis, which had caused a curve of over 100 degrees, previously considered inoperable. The 54-year-old patient had suffered a pathological fusion (ankylosis) of five thoracic vertebrae: the spine, curving forward, had caused a kyphosis that prevented her from standing or walking. Numerous surgeries had been unsuccessful, and the deformity was considered inoperable due to the extremely high risk of spinal cord injury, trapped within the curve. The one-of-a-kind surgery was performed by the team led by Professor Cesare Faldini, director of the Orthopedic Clinic 1 at the Rizzoli Orthopedic Institute, supported by anesthesiologists, resuscitators, neurophysiologists, and nurses, and lasted approximately eight hours. An absolute innovation for this type of surgery was the use of a 3D reconstruction technique of the deformed spine based on the patient's CT scan. This allowed the team to plan the removal of the two vertebrae and "guide" the correction without damaging the spinal cord, achieving a correction of over ninety degrees in a single procedure. "A result previously unthinkable," Faldini specifies, "achieved by combining tradition in orthopedic research. Rizzoli celebrates its 125th anniversary these days, using highly innovative techniques to offer surgical correction for those rare scoliosis and kyphosis conditions previously considered inoperable due to their severity. These situations are fortunately rare, but they seriously impair patients: if the spine deforms beyond ninety degrees, that is, at a right angle, it becomes horizontal from vertical, making it impossible to stand and maintain an acceptable social life. These patients, despite having an intact spinal cord, have voluntary control of their legs but are unable to use them and are forced to sit due to the shape of their spine." From the patient's CT scan, it was possible to perform a 3D reconstruction of the deformity to plan the removal of the eighth and twelfth thoracic vertebrae and simulate the spinal realignment maneuver without damaging the spinal cord. Twelve templates were also designed using the patient's CT scan. These templates, constructed using 3D printing, allowed the screws to be inserted into the vertebrae through the pedicles, compromised by the deformity and previous surgeries. "The procedure is the combination of expertise acquired over years of study and research in the field of severe scoliotic and kyphotic spinal deformities," explains Faldini, "to which must be added the evolution of 3D research to be able to propose surgical solutions that until now were considered too risky." The patient, after a brief period in intensive care, was assisted in the inpatient ward by nursing staff: on her feet seven days after the surgery, she began the rehabilitation process to begin walking again. "The simultaneous removal of multiple vertebrae to realign the spine is a significant step forward," concludes Faldini, "as it offers a solution for correcting severe kyphosis and scoliosis that cannot be treated with alternative techniques. In this field, the Rizzoli Institute's reputation extends far beyond national borders: the prestigious American magazine Newsweek ranked us eleventh among the world's leading orthopedic practices, and in terms of research, a 'simplified preview' of this procedure, presented in the United States at the prestigious American Academy of Orthopaedic Surgeons in 2020, was awarded the best scientific work in the field of spinal surgery."