Posterior vertebral column resection for congenital rigid spinal deformities

Abstract

Background: The goal in surgical management of complex spinal deformities is to safely realign the spine as much as possible in both sagittal and coronal planes. Standard posterior and or middle column osteotomies are associated with limitations to correct the severe rigid curves. The purpose of this study was to assess the clinical and radiographic results of posterior vertebral column resection (PVCR) for surgical management of complex congenital rigid spinal deformities. Methods: Thirty-five patients with congenital rigid spinal deformities were enrolled in this prospective study. Preoperative measurement of curve magnitude and stiffness was done. Postoperative degrees of correction also were measured. The mean percentage of correction was calculated. Intraoperative and postoperative complications were reported. The minimum follow-up period was 2 yr. Results: Nineteen patients had rigid kyphosis and 16 had kyphoscoliosis. Their etiologies were due to congenital vertebral anomalies. An average of 1.5 vertebrae were resected intraoperatively. Radiographically the mean preoperative kyphosis was 68.9 degrees and in those patients with kyphoscoliosis, the mean preoperative value was 38 degrees. They improved on immediate follow-up to 24.5 and 11 degrees, respectively. At final follow-up the mean loss of correction in the sagittal plane was 3.6 degrees, which was statistically insignificant. All patients showed solid fusion at final follow-up. Complications were noted in seven patients, including dural tear, pleural tear, and postoperative wound infection that were managed accordingly. Conclusions: Single-stage PVCR is a highly effective option in the management of rigid spinal deformities with satisfactory clinical and radiographic outcomes.