Transpedicular Expanded Eggshell Technique Vertebral Column Resection for Serious Rigid Kyphoscoliosis in Adults

Summary of Background Data: Transpedicular eggshell osteotomies and vertebral column resection is a formidable operation reserved for rigid severe deformities. The authors devised a technique combined two techniques in treatment of adult congenital kyphoscoliosis through a single posterior approach.

Methods: From 2001 to 2003 sixteen serious rigid congenital kyphoscoliosis deformity adult patients were reviewed, who were treated by posterior transpedicular expanded eggshell technique VCR, 6 males and 10 females with a mean age of 31.8?range 21.5-44.2 years old). Three-dimensional reconstructive images were used for preoperatively osteotomy levels selecting and accurately pedicle screws placing. The surgery consisted of one-stage posterior transpedicular eggshell technique, and then expanded the eggshell to the adjacent inter-vertebra space, range of resection of the vertebral column at the apex of the deformity, including AV and both cephalic and caudal adjacent wedge vertebra. Posterior elements were removed, after completion of the VCR, closure was obtained by gradually cantilever and compression technique.

Results: Average 1.6 vertebra were resected. Mean operation time was 256 min with average blood loss of 2250 ml. Mean 32mm shorten was measured during operation, and 22 mm lengthen in standing post-operation. In this group, average follow-up was 2.6 years (range 2.1-3.5 years). Deformity correction was 52.3% in the coronal plane and 75.1 in the sagittal plane. Complications were encountered in 4 patients: 2 transversal spinal injury and 2 root injuries (all incomplete).

Conclusions: Posterior transpedicular expanded eggshell technique VCR is an effective alternative for serious congenital rigid kyphoscoliosis in adults.