Posterior Vertebral Column Resection for Severe Pediatric Deformity

Abstract

Retrospective review of a prospectively accrued patient cohort. The ability to treat severe pediatric spinal deformity through an all-posterior vertebral column resection (VCR) has obviated the need for a circumferential approach in both primary and revision settings. We examined indications, correction rates, and complications of this challenging procedure in the pediatric population. Traditionally, severe pediatric spinal deformities were treated through a combined anterior/posterior spinal fusion. Between 2000 and 2005, 35 consecutive patients underwent a posterior-only VCR by 1 of 2 surgeons at a single institution. Patients were divided into 5 diagnostic categories: (1) severe scoliosis (S) (n = 2; mean, 115 degrees; range, 79-150 degrees; average flexibility, 12%); (2) global kyphosis (GK) (n = 3; mean, 101 degrees; range, 91-113 degrees; average flexibility, 16%); (3) angular kyphosis (AK) (n = 10; mean, 86 degrees; range, 45-135 degrees, average flexibility, 23%); (4) kyphoscoliosis (KS) (n = 8; mean kyphosis, 103 degrees/scoliosis 87 degrees; mean combined, 190 degrees; range, 144-237 degrees); (5) congenital scoliosis (CS) (n = 12; mean, 43 degrees; range, 23-69 degrees; average flexibility, 20%). There were 20 primary/15 revision surgeries. There were 20 one-level, 11 two-level, and 4 three-level resections. The major curve correction averaged: Group S = 61 degrees/51%, Group GK = 56 degrees/55%, Group AK = 51 degrees/58%, Group KS = 98 degrees/54%, and Group CS = 24 degrees/60%. The average OR time was 460 minutes (range, 210-822), with an average EBL of 691 mL (range, 125-2200). There were no spinal cord-related complications; however, 2 patients (8.5%) lost intraoperative neuromonitoring data during correction with data returning to baseline following prompt surgical intervention. Two patients had implant revisions, 1 for a delayed deep infection at 2 years and the other for implant prominence at 3-year follow-up. A posterior-based VCR is a safe but challenging technique to treat severe primary or revision pediatric spinal deformities. Intraoperative SCM (especially motor-evoked potentials) is mandatory to prevent spinal cord-related neurologic complications. Dramatic radiographic and clinical correction of these deformities can be obtained via a posterior-only approach.