Neurologic Status: 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

Table 3: Complications of 43 Patients

Neurologic
Following surgery, all patients were at their baseline (n=40) or showed improved spinal cord function (n=3), while no one worsened. Seven patients (18%) lost intraoperative NMEP data during correction with data returning to baseline following prompt surgical intervention. All seven of these patients had some form of preoperative kyphosis (GK-1, AK-2, and K+S-4). Five of the seven patients had some type of spinal column subluxation occur during the vertebrectomy site closure. In five of the patients, subluxation occurred with actual closure of the vertebrectomy site with the most common impingement being the ventral aspect of the proximal level of the spinal cord. In one patient (GK) NMEP data were lost with closure, and returned with reopening the osteotomy site and closure over a cage. (Figure 3) In another patient (AK), over-shortening of the spinal cord occurred with closure over a small cage. When a larger cage was inserted with compression, the data remained normal. All seven of these patients had NMEP data return to baseline promptly following the surgical correction of subluxation or placement of a larger anterior cage.

Figure 3A-H. Patient is an 18+6-year-old female with a combined Scheuermann's/congenital kyphosis.

Figure 3A. She had a +105-degree sagittal plane deformity, correcting to only +98° (6%) on hyperextension.

Figure 3B. Her preoperative MRI showed ventral dural compression along the entire posterior edge of her global kyphosis deformity as well as fused posterior apical facet joint. She also exhibited exertional myelopathy. Statically she had normal neurology, but after walking for longer than 15 minutes, her legs became heavy, numb, and she exhibited bilateral clonus and up-going toes.

Figure 3C. Further complicating the matter was her weight at 285 pounds (preop clinical photos).

Figure 3D. She underwent a single-level posterior vertebral column resection (VCR) with anterior cage placement, following closure of her deformity over the cage;

Figures 3E. NMEP data was lost bilaterally, with return of data following release of her correction, and placement of a larger cage.

Figure 3F. She eventually had her final construct with intact NMEP data with rib bridge strut grafts placed over the laminectomy defect for the definitive posterior instrumentation and fusion.

Figure 3G. Her one-year postoperative films show correction of her kyphosis to +46° with normal coronal and sagittal radiographic contours.

Figure 3H. Her pre and postoperative clinical photos are demonstrated.