Posterior Vertebral Column Resection (VCR) for Severe Pediatric and Adult Spinal Deformity: Indications, Results, and Complications of 43 Consecutive Cases

Kathy M. Blanke, RN
Washington University School of Medicine
St. Louis, MO

Scoliosis Research Society Paper 13
42nd Annual Meeting
Edinburgh, Scotland
September 5-8, 2007

Introduction
The surgical treatment of severe spinal deformity has traditionally been based on a circumferential approach to the spinal column. (16,17,20) In a first stage anterior approach, multilevel discectomies and/or corpectomies are performed for release of the rigid spinal column. In addition, anterior spinal fusion is obtained through grafting of the released disc spaces, and/or placement of morselized vertebral body bone back into any corpectomy defects that were performed in anticipation of a circumferential vertebrectomy procedure. Then, either on a same-day or staged basis, a posterior procedure is performed for instrumentation, correction, and ultimate fusion. Concomitant with the posterior approach, posterior releases of the ligaments and facet joints (Ponte or Smith-Petersen type osteotomies) are performed versus a posterior laminectomy and pediclectomy for completion of a circumferential vertebral column resection (VCR) approach. This approach has been the standard of care of severe, rigid spinal deformities for several decades once segmental spinal instrumentation made stable instrumentation constructs possible for the treatment of these severe deformities.

Performing a circumferential VCR approach for severe, rigid spinal deformity was first described by Bradford in the late 1980s.(1) He was the first to describe the use of a circumferential vertebral column resection coupled with concave rib osteotomies, convex thoracoplasty, and segmental spinal instrumentation with fusion in 13 patients with severe structural spinal deformities. In 1997, he and O. Boachie-Adjei (2) further expanded on Bradford's original case series by which they reported on 16 patients undergoing a circumferential VCR. Excellent deformity correction and rebalancing of the trunk was reported with few serious complications. More recently, Suk et al reported on a posterior-only approach with a VCR for fixed lumbar spinal deformities (3), as well as for severe, rigid scoliosis. (4,5) They reported excellent surgical correction with minimal long-term complications for lumbar deformities resected around the cauda equina region, with similar results for the thoracic scoliosis patients except for one permanent paraplegia postoperative. To date, no North American clinical series has reported on this technique for the treatment of primarily thoracic-based, severe pediatric and adult spinal deformities.

The purpose of this study was to examine the indications, correction rates, perioperative and postoperative morbidity and complications of an all-posterior VCR approach for the treatment of severe pediatric and adult spinal deformity by a single surgeon. This posterior VCR approach has obviated the need for a circumferential approach in both primary and revision settings for all patients with severe spinal deformities since 2002.