Radiographic Results: Vertebral Column Resection (VCR) for Severe Pediatric and Adult Spinal Deformity

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

Radiographic
The major curve correction was 73° (69%) for the scoliosis cases, 46° (54%) for the global kyphosis cases, 48° (63%) for the angular kyphosis cases, and a combined 110° (55%) for the kyphosis + scoliosis cases. For the severe scoliosis cases, the mean preoperative coronal Cobb of 85° had a preoperative flexibility of 75° (11%), with initial curve correction averaging 25°, and ultimate correction averaging 28° (69%). For the global kyphosis cases, the preoperative maximum sagittal Cobb of +93° (range 70-+120°) had a preoperative flexibility averaging +78° with initial postoperative correction averaging +46°, and ultimate correction averaging +48° (54%). For the angular kyphosis case, the average preoperative kyphosis of +72° had an average preoperative extension lateral measurement of +46° with initial correction averaging 23°, ultimate correction 24° (63%). Lastly, for the kyphoscoliosis cases, the preoperative mean total kyphosis + scoliosis measurement was 194°, with a combined 103° of initial correction, and 107° of ultimate correction (55%). No patient thus far has required revision surgery for instrumentation, or fusion complications. (Figure 2)

Figure 2A-D. Patient is a 17+8-year-old female with severe idiopathic kyphoscoliosis.

Figure 2A. She had a 135-degree coronal plane deformity bending to only 121° (11% flexibility), and a +140-degree kyphosis deformity. Thus, she had 275° of total kyphoscoliosis deformity.

Figure 2B. Preoperatively, she was placed in halo-gravity traction for four weeks to stretch out her spinal column and to improve her nutritional and respiratory statuses. Her ultimate coronal plane deformity corrected to 102° and her sagittal plane to +89°.

Figure 2C. She underwent a two-stage T10 VCR with PSF from T2 to L4. Her ultimate coronal plane correction was to 39° (72% correction) with sagittal plane correction to +24° (88%).

Figure 2D. Pre and postoperative clinic photos show marked correction of her trunk with a concomitant seven-rib thoracoplasty performed in order to gain full access of her posterior spinal column because of her severe deformity.