Posterior Vertebral Column Resection for Severe Spinal Deformities

Inje University Sanggye Paik Hospital, Seoul, Korea

Vertebral column resection is a formidable operation reserved for severe fixed spinal deformities. Authors devised a new technique of posterior vertebral column resection (PVCR) that offers significant advantages over the combined anterior-posterior VCR.

PURPOSE:
This paper is to report a new technique of vertebral column resection through a single posterior approach and its first results.

MATERIALS AND METHODS:
70 spinal deformity patients treated by PVCR were retrospectively reviewed after a minimum follow up of 2 years (range: 2 ~ 3.5 years). There were 34 males and 36 females with a mean age of 27.4 years at the time of the operative intervention. Etiologic diagnoses were adult scoliosis in 7 patients, congenital kyphoscoliosis in 38, post-infectious (post-tuberculosis) kyphosis in 25.The primary indication of PVCR was fixed decompensation with severe deformities of the spine that could not be brought to a reasonable balance on traction or forced side bending. Patients with less severe deformities were subjected to the procedure when anterior-posterior surgery was considered detrimental or less effective (e.g. a large bony block at the apex of the deformity). The surgery consisted of temporary stabilization of the vertebral column with segmental pedicle screw fixation, resection of the vertebral column at the apex of the deformity via the posterior route followed by gradual deformity correction and global fusion. The amount of resection was determined preoperatively, considering a correction of 30 degrees per vertebra resected.

RESULTS:
The total numbers of vertebral segments removed were 139 segments, 72 in thoracic and 67 in lumbar level, respectively. In average, 1.4 segments in adult scoliosis, 3.6 in postinfectious kyphosis and 1.1 for congenital kyphoscoliosis were removed. Mean operation time was 4 hours 31 minutes with a blood loss of 3431 ml. The deformity correction was 63% in coronal plane (from 64° to 24°), and 50° in sagittal plane (from 58° to 8°). Complications were encountered in 17 patients (24.3%). They comprised 2 complete cord injuries each in severe adult scoliosis and thoracic kyphosis patient who had significant preoperative cord compromise. There were 5 hematoma, 4 root injuries (all incomplete), 4 fixation failure and 2 infections.

CONCLUSIONS:
PVCR is an effective alternative for severe fixed spinal deformities. However, extreme caution must be taken in the patients with preoperative cord compromise who are at high risk of neurological complications.