Comparison of Posterior Unilateral Vertebral Column Resection Versus Posterior Vertebral Column Resection for Severe Thoracolumbar Angular Kyphosis as a Revision Surgical Modality: A Retrospective Cohort Study.

Abstract

Objective:The objective of this study was to determine the safety and efficacy of posterior unilateral vertebral column resection (PUVCR) as revision surgery for severe thoracolumbar angular kyphosis.Patients and Methods:This is a retrospective cohort study. Adult patients undergoing revision surgery for severe thoracolumbar angular kyphosis in 2010–2016 with ≥2-year follow-up at our institution were assessed. Perioperative complications and clinical outcomes, including blood loss, operation time, Visual Analog Scale score, Oswestry Disability Index, and preoperative and postoperative kyphotic angles, were analyzed.Results:This study included 58 patients who were divided into the PUVCR group and the posterior vertebral column resection (PVCR) group. Age (P=0.810), sex distribution (P=0.500), and vertebrae that underwent surgery (P=0.638) were similar in the 2 groups. Shorter mean operation time was observed in the PUVCR group as compared with the PVCR group (P<0.001). In addition, less blood loss was recorded in the PUVCR group as compared with the PVCR group (P=0.001). There were no significant differences between the 2 groups in a change of Visual Analog Scale scores postoperation versus preoperation (P=0.961), and at postoperative 3 months (P=0.906), 12 months (P=0.752), and 24 months (P=0.811) versus postoperation, respectively. There were no significant differences between the 2 groups in Oswestry Disability Index changes postoperation versus preoperation (P=0.157), and at postoperative 3 months (P=0.899), 12 months (P=0.947), and 24 months (P=0.811) versus postoperation, respectively. PUVCR and PVCR were comparable in deformity correction (P=0.434) and final angle correction (P=0.790). Complication rates in the PUVCR and PVCR groups were 7.1% and 36.7%, respectively.Conclusion:PUVCR has comparable safety and efficacy to PVCR in treating severe thoracolumbar angular kyphosis, with the advantages of the shorter operation time, less blood loss, and fewer complications.