Posterior Vertebral Column Resection (VCR) for Complex Spinal Deformities

Abstract

Vertebral column resection (VCR) for severe spinal deformity was first described in the 1970s and 1980s [1–3], though vertebrectomy as a surgical procedure has been employed since the 1920s for treatment of scoliosis [4]. A circumferential VCR approach to the surgical management of severe pediatric and adult deformities was considered as a viable option, as the development of segmental instrumentation made stable posterior constructs—and thus successful manipulation of the severely deformed spine—possible. Throughout the 1990s, the described series of patients undergoing VCR for deformity correction continued to slowly expand in both the pediatric and adult populations [5, 6]. The technique itself involves resection of the vertebral body and discs from a formal anterior approach, as well as removal of the posterior elements and posterior instrumentation and fusion from the posterior approach [7]. Recent developments in posterior-only exposures to achieve resection of the anterior column have obviated the requirement for traditional anterior and posterior approaches [8, 9], and the technique continued to gain relative popularity for the treatment of severe pediatric and adult spinal deformities [10–12]. Posterior-only VCR allows the procedure to be completed in one stage, thus reducing overall operative time and blood loss, and providing the greatest amount of surgical correction when compared to all other spinal osteotomy types [7]. The advantage of posterior VCR over traditional pedicle subtraction osteotomy (PSO) is that one obtains complete control and access of the spinal column and spinal cord during the disarticulation of the proximal and distal ends of the spinal column being realigned [13].