Asymmetric T1 Pedicle Subtraction Osteotomy for Rigid Cervicothoracic Kyphoscoliosis: Radiological Outcomes and Perioperative Safety Evaluation

Abstract Background Rigid cervicothoracic kyphoscoliosis is a complex spinal deformity involving both coronal and sagittal malalignment of the cervicothoracic junction. Safe and satisfactory deformity correction remains challenging owing to the complicated neurovascular anatomy in this region. The present study aims to investigate the clinical efficacy of asymmetric T1 pedicle subtraction osteotomy for rigid cervicothoracic kyphoscoliosis. Methods Fifteen patients with rigid cervicothoracic kyphoscoliosis who underwent asymmetric T1 PSO from June 2012 to October 2022 were retrospectively enrolled, including 11 males and 4 females with a mean age of 53.1 ± 10.7 years (range, 43–69 years). Operative time, estimated blood loss, and peri-and post-operative complications were documented. Radiographic parameters including chin‑brow vertical angle (CBVA), cervicothoracic kyphotic Cobb angle, cervicothoracic scoliotic Cobb angle, and C2-T1 sagittal vertical axis (SVA) were measured preoperatively, postoperatively, and at final follow-up. Deformity correction rates were calculated to evaluate surgical efficacy. Results All patients achieved a mean follow-up of 33.2 ± 9.1 months (range, 22–50 months). Mean operative time was 292 min (range, 240–335 min), and mean blood loss was 1580 mL (range, 1250–2150 mL). According to radiographic measurements, mean CBVA improved from 98.6°±13.5° preoperatively to 26.2°±8.6°at final follow-up. Mean cervicothoracic kyphotic Cobb angle changed from 23.4°±9.8°pre‑operatively to − 15.6°±9.4° at final follow-up. Mean cervicothoracic scoliotic Cobb angle decreased from 15.3°±1.3° to 2.3°±0.2°. Mean C2-T1 SVA decreased from 11.2 ± 4.5 cm to 6.4 ± 2.6 cm. Repeated-measures ANOVA revealed statistically significant differences for all parameters across time‑points (P < 0.001). Two patients presented transient numbness and weakness of the left hand, which resolved within three months with conservative management. Two other patients had delayed wound healing that improved after symptomatic treatment. No permanent neurological deficits or implant-related failures (screw loosening, rod breakage, screw fracture) occurred. Coronal and sagittal spinal balance was preserved in all patients at the final follow-up. Conclusion Asymmetric T1 PSO is a safe and effective surgical technique for rigid cervicothoracic kyphoscoliosis, offering satisfactory deformity correction with a low risk of complications.