Modification in Surgical Technique for Posterior Vertebral Column Resection

Abstract

Introduction Surgical treatment of severe and rigid spinal deformities is usually difficult and challenging to perform. The goal of surgical treatment is to obtain a satisfactory balance both in sagittal and coronal planes. In rigid deformities, the osteotomies are usually insufficient; vertebral column resection is the only option of treatment. To reduce the operation time and complications, a single stage, posterior vertebral column resection (PVCR) is defined by Suk et al. It enables rotational and translational correction of spinal column and provides an opportunity for manipulation of anterior and posterior column simultaneously. In the original PVCR, posterior elements of resection side were removed first and then the anterior part removed and correction was performed. The authors decided to make a modification in PVCR as performing the posterior total laminectomy, facetectomy, and pediclectomy after vertebral body resection. This method has two major advantages; minimization of the blood loss from epidural veins after laminectomy and protection of the neural elements from direct injury during vertebral body resection. Patients and Methods A total of 11 patients between the age of 3 and 63 years, diagnosed with severe spinal deformity with limited flexibility, who underwent modified PVCR were reviewed. The average follow-up was 2 years (range, 5 months–3 years). There were six female and five male patients with a mean age of 18 years. Severe congenital scoliosis was found in seven patients, congenital kyphosis in two patients, neurofibromatosis in one patient, and posttraumatic kyphosis in one patient. The surgery consisted of temporary fixation of vertebral column, resection of vertebral body first then resection of posterior elements, followed by deformity correction and fusion. Results The mean estimated blood loss was 1,072 mL (range, 350–2,000 mL). Overall, 39.45% (range, 33–50%) of total blood loss occurred after vertebral body resection, 60.91% (range, 50–67%) occurred after posterior elements removal. The ratio of estimated blood loss to estimated body blood volume was 26% (range, 19–52%). The deformity correction was 60% in the coronal plane. No neurological complications were encountered. Conclusion The PVCR is a complicated, technically demanding procedure with possible risks for major complications. All correction attempts must be performed under direct inspection, palpation of tension in the spinal cord by a highly experienced surgeon. Spinal cord neuromonitoring is a must to prevent neurological injuries. The authors modified the original technique defined by Suk and performed by various surgeons. The authors believe that making vertebral body resection before laminectomy would decrease the blood loss and protect the spinal cord. The validity of this new modified technique should be demonstrated in a prospective, randomized, controlled study with a larger patient population allowing comparison of age-matched subgroups.