Single Stage Vertebral Column Resection for the Correction of Severe Rigid Kyphosis

The King Edward Memorial Hospital, Mumbai, India

This paper evaluates the outcome of single stage vertebral column resection and spinal shortening in the correction of severe rigid kyphotic deformities in adolescent patients.

Adolescents with rigid kyphosis present a therapeutic challenge with regard to cosmetic deformity, backache and neurologic deficit. It is imperative to treat them early to prevent undesirable sequel and restore physiologic posture.

We present a retrospective study of 21 patients with severe rigid kyphosis treated by single stage transpedicular vertebral decancellisation procedure. Of the 21 patients, 13 were due to tuberculosis and 8 had a congenital anomaly. The average age was 12 years (6-16 yrs) and the average kyphosis was 75 degrees (38-135 degrees). The deformity was middorsal in 6, dorsolumbar in 14 and lumbar in 1 patient. 5 cases had neurologic deficit, 3 being acute and 2 late onset paraplegias. Plain radiographs, CT and MRI scans were used for preoperative evaluation. The surgery included transpedicular vertebral decancellisation, spinal column shortening, interbody fusion and segmental spinal instrumentation. All the patients were followed up for a minimum period of 36 months (36- 60 months).

At follow-up, the average correction was 61% and all cases were adequately fused. Of the 5 cases with neurology, 4 recovered completely while one had postoperative deterioration and recovered incompletely. (residual spasticity but ambulant). The average loss of correction was 6 degrees. One patient had a decompensated lordosis due to failure of inclusion of the distal lumbar end vertebrae. Other than the aforementioned cases, there was no other complication.

Vertebral column resection allows adequate decompression, deformity correction, spinal fixation and fusion is a single procedure. It appears to be a safe but highly demanding technique of correcting rigid kyphosis in adolescent children.