Posterior Vertebral Column Resection (PVCR) in Early Onset Spinal Deformities (EOSD)

Abstract

Introduction Early onset spinal deformities (EOSD) are spinal deformities before five years. Early surgical intervention is often necessary to avoid the eventually disastrous complications due to deformity progression like restrictive pulmonary functions. Posterior vertebral column resection (PVCR) achieves the best correction in severe and complex deformities. We present our experience in PVCR in five cases with EOSD. Patients and Methods PVCR was done in five cases (2 males and 3 females) with congenital hemivertebra with a mean age of 4.3 years. Two cases were only kyphotic while the other three cases had additional scoliosis. One case presented with progressive lower limb spasticity. All cases were managed by one level PVCR. Shilla growth guiding technique was done in two cases to allow future growth. One patient had short segment fusion, and two had long segment fusion. The patients were followed up for a mean of 21 (12–36) months. Results The patient with paraplegia improved completely over the three postoperative months. The local kyphosis improved by 92% (59° to 4.5°). The mean thoracic kyphosis improved by35% (38.25° to 24.5°). The mean sagittal vertical axis decreased by 71% and 19% (38.37 to 11 to 30.8 mm) postoperatively and at last follow up respectively. Lumbar lordosis reduced by 22% (47.5° to 37°). The associated scoliosis completely corrected from 29° to 0°. The mean operation time was 482.5 minute, with 3075 ml blood loss. One patient with myelocele had pseudarthrosis and metal failure necessitated revision. The patient with short segment fixation developed an asymptomatic, non-progressive proximal junctional kyphosis immediately postoperatively. No revision or extension of fusion was needed. Conclusion PVCR appears to be an effective technique to treat severe EOSD with limitation of fused segments to allow further growth.