Posterior Vertebral Column Resection for Severe Spinal Deformities

Abstract

Purpose : To report a technique of vertebral column resection using a single posterior approach and its results in the treatment of severe spinal deformities. Materials and Methods : Seventy spinal deformity patients treated by posterior vertebral column resection (PVCR) were retrospectively reviewed with minimum follow up of 2 years (2-3.3 years). There were 34 males and 36 females with a mean age of 27.4 years. Etiologic diagnoses were; adult scoliosis in 7, congenital kyphoscoliosis in 38, and post-infectious kyphosis in 25. The surgery consisted of temporary stabilization of the vertebral column with segmental pedicle screw fixation, resection of the vertebral column at the apex of the deformity via the posterior route followed by gradual deformity correction and fusion. Radiological and clinical data were reviewed for deformity correction and clinical results. Results : The total number of resected vertebrae were 143; 76 thoracic and 67 lumbar. Mean operation time was 4 hours 31 minutes with an average blood loss of 2,333 mL. The deformity correction was 62.9% in the coronal plane and in the sagittal plane. Complications were encountered in 24 patients; 2 complete cord injuries in severe adult scoliosis and a single thoracic kyphosis patient who had significant preoperative cord compromise, 6 hematomas, 4 root injuries (all incomplete), 5 fixation failures, 2 infections and 5 hemopneumothoraxes. Conclusion : PVCR is an effective alternative for severe fixed spinal deformities. However, extreme caution must be taken in patients with preoperative cord compromise who have a high risk of neurological complications.