Surgical Outcome Comparison of Posterior Vertebral Column Resection with or without Anterior Column Support in Treatment of Yang’s Type A Severe Thoracic Spinal Deformity

Abstract

The use of posterior vertebral column resection (PVCR) has extended the treatment of severe spinal deformity. However, the practice guidelines for anterior column support in patients treated by PVCR remain ill defined. The objective of the present study was to compare the clinical and radiographic outcomes of severe thoracic spinal deformity treated by PVCR with and without anterior column support (ACS). We performed a prospective study of 57 patients with severe thoracic deformity (classified as Yang's A type) treated by PVCR with or without anterior column support from January 2010 to April 2015. The patient characteristics, radiographic parameters, intraoperative data, and complications were analyzed to clarify these 2 clinical series. The sex, age, diagnosis, curve magnitude, and curve type were similar between the PVCR with ACS group (n= 21) and non-ACS group (n= 36) preoperatively. Evaluation of the radiographic parameters, intraoperative data, and complications found no statistically significant intergroup differences, except for the osteotomy distance (non-ACS group, 4.0 cm; ACS group, 5.3 cm; P < 0.001) and shortening distance of the osteotomy gap (non-ACS group, 4.0 cm; ACS group, 3.5 cm; P= 0.005). The results of the present study have shown that PVCR without ACS seems to be a safe and effective technique for Yang's A type severe thoracic spinal deformity correction compared with PVCR with ACS. PVCR without ACS requires a relatively smaller osteotomy range and could potentially decrease the risk of implant failure due to bone to bone fusion.