Posterior-only Vertebral Column Resection Research Articles

Posterior-Only Vertebral Column Resection for Fused Spondyloptosis

Study DesignRetrospective review. ObjectivesTo describe 3 cases of a posterior-only vertebral column resection (pVCR) for the treatment of spondyloptosis in the setting of prior spinal fusions. Summary of Background DataLumbosacral spondyloptosis is a rare spinal deformity with a number of surgical options, none of which demonstrate clear superiority. The use of an L5 vertebral column resection, via combined anterior and posterior approaches, to restore lumbosacral alignment has been described though is accompanied by high rates of neurological deficit. MethodsReview of 3 cases of spondyloptosis with prior spinal fusions in which a staged pVCR was used for deformity reconstruction. ResultsThree females, ages 39, 54, and 28, developed spondyloptosis with progressive lumbosacral kyphosis and sagittal malalignment after prior in-situ posterolateral spinal fusions. All were treated with staged pVCRs. At ultimate follow-up, imaging revealed improvement in sagittal balance of 6.1 cm (56%) in the 39-year-old and 12 cm (67%) in the 54-year-old, 21.1 cm (92%) in the 28-year-old. All patients had improvement in outcome scores with perfect satisfaction scores despite the 54-year-old having a persistent right foot drop. ConclusionPosterior-only VCR for spondyloptosis is a technically demanding surgical option offering significant radiographic and clinical improvement, but carries a risk for L5 nerve root deficit as in any spondyloptosis treatment.

Severe Rigid Scoliosis: Review of Management Strategies and Role of Spinal Osteotomies.

Severe rigid curves pose a considerable challenge to the treating spine surgeon. In our practice, approximately 30%–40% of patients with scoliosis present late with severe rigid scoliosis (>90° and <30% correction on bending films). Controversy still exists with regard to the ideal surgical strategy for correcting these rigid curves. Rigid scoliosis often presents in the form of either sharp angular or rounded deformities. Rounded deformities can be effectively managed with an anterior release to loosen the apex and posterior instrumentation (with osteotomies, if required). In contrast, severe rigid scoliosis, which is a sharp angular deformity, is not very amenable to anterior release and is best managed by posterior-only vertebral column resection and posterior instrumentation.

Single-stage Transpedicular Vertebrectomy and Expandable Cage Placement for Treatment of Unstable Mid and Lower Lumbar Burst Fractures.

Retrospective clinical and radiographic study. To examine the efficacy and safety of vertebrectomy and expandable cage placement by a single-stage posterior approach for unstable mid and lower lumbar burst fractures (below the L3). Patients with unstable mid and lower lumbar burst fractures require surgical treatment to relieve pain, address paralysis, and stabilize the spine to prevent further segmental deformity. However, controversy remains regarding the optimal surgical treatment. Eleven patients underwent single-stage posterior-only vertebral column resection and vertebral body reconstruction using an expandable cage. Neurological status was classified using the American Spinal Injury Association (ASIA) Impairment Scale, whereas functional outcome was analyzed using a visual analog scale for back pain. Segmental Cobb angles were measured above and below the fractured vertebral body preoperatively, immediate postoperatively, and at the last follow-up. The preoperative neurological status was ASIA grade E in 2 patients, grade D in 5 patients, grade C in 2 patients, and grade B in 2 patients. Postoperatively, neurological stability was demonstrated in 3 patients (27%), and 8 (73%) showed improvement in the ASIA grade. The mean preoperative visual analog scale score was 8.3, which decreased to 4.5 postoperatively, and to 1.8 at the final follow-up. The mean preoperative segmental lordotic angle was 9.2 degrees, which increased to 16.9 degrees postoperatively, and decreased to 15.1 degrees at the last follow-up. The mean operating time was 208.8 minutes, and the mean blood loss was 1006.3 mL. Regarding surgical complications, 1 patient experienced a dural tear and 1 patient demonstrated cage subsidence. The results of this small series suggest the feasibility, efficacy, and safety of this surgical option for unstable mid and lower lumbar burst fractures. This technique from a single posterior approach offers several advantages over traditional anterior or combined approaches using strut graft or nonexpandable implants.

Posterior Only Vertebral Column Resection for the Treatment of Severe Spinal Deformities in Pediatric Patients: A Retrospective Case Series.

The treatment of severe spinal deformities in pediatric patients is very challenging. Posterior only vertebral column resection (PVCR) allows for correcting of severe deformities of the vertebral column via a posterior only procedure. We analyzed radiologic outcome of PVCR performed on a series of pediatric patients with severe congenital and acquired spinal deformities. A case series of 11 pediatric patients with severe spinal deformity who were treated by PVCR between 2009 and 2013 were retrospectively analyzed. All patients had posterior instrumentation and reconstruction of the anterior column with titanium cages filled with autologous bone. Seven patients had pure kyphosis or kyphoscoliosis, whereas 4 patients were treated because of scoliotic deformities. The patient records were reviewed for demographic and general clinical data. Complications and adverse events, transfusion rates, and surgical time were recorded. Radiologic analysis included Cobb angles and percentage of correction, analysis of sagittal profile, time to fusion, and possible complications related to instrumentation. Average preoperative scoliosis of 61° was corrected to 32°, resulting in a 50% correction at final follow-up. Coronal imbalance was improved to 36% at the most recent follow-up. Mean preoperative kyphotic deformity was 90° and was corrected to 43° at the last follow-up evaluation. Intraoperative complications included loss of the neuromonitoring signals in 2 cases and pleural laceration in 1 case. PVCR for children is an effective and safe technique providing a successful correction of complex pediatric spinal deformities. Nevertheless, it remains a technically highly demanding procedure, implying the possibility of severe complications.

Single-Stage Posterior Vertebral Body Resection and Reconstruction Using Expandable Cage for Unstable Mid and Lower Lumbar Burst Fractures

Introduction Patients with unstable mid and lower lumbar burst fractures require surgical treatment to relieve pain, address paralysis, and stabilize the spine to prevent further segmental deformity. However, controversy remains regarding the optimal surgical treatment. The purpose of this study is to examine the efficacy and safety of corpectomy and expandable cage placement via a single-stage posterior approach for unstable mid and lower lumbar burst fractures (below the L3). Patients and Methods A total of 11 patients underwent single-stage posterior-only vertebral column resection and vertebral body reconstruction using an expandable cage. Neurologic status was classified using the American Spinal Injury Association (ASIA) Impairment Scale, while functional outcome was analyzed using a visual analog scale (VAS) for back pain. Segmental Cobb angles were measured above and below the fractured vertebral body preoperatively, immediate postoperatively, and at the last follow-up. Results The preoperative neurologic status was ASIA grade E in two patients, grade D in five patients, grade C in two patients, and grade B in two patients. Postoperatively, neurologic stability was demonstrated in three patients (27%), and eight patients (73%) showed improvement in the ASIA grade. The mean preoperative VAS score was 8.3, which decreased to 4.5 postoperatively, and to 1.8 at the final follow-up. The mean preoperative segmental lordotic angle was 9.2 degrees, which increased to 16.9 degrees postoperatively, and decreased to 15.1 degrees at the last follow-up. The mean operating time was 208.8 minutes, and the mean blood loss was 588 mL. Regarding surgical complications, one patient experienced a dural tear and one patient demonstrated cage subsidence. Conclusion The results of this small series suggest the feasibility, efficacy, and safety of this surgical option for unstable mid and lower lumbar burst fractures. This technique from a single posterior approach offers several advantages over traditional anterior or combined approaches using strut graft or nonexpandable implants.

Predicting Kyphosis Correction During Posterior-Only Vertebral Column Resection by the Amount of Spinal Column Shortening

Study DesignRetrospective. ObjectiveTo investigate the relationship between the amount of correction achieved (K°) and extent of vertebral column shortening (mm) with posterior vertebral column resection (PVCR). Summary of background dataThere is no scientific reference to the correlation between K° and column shortening (mm) with PVCR. MethodsBased on simple geometry, we tested the hypothesis that we could predict the amount of actual kyphosis correction (K°) by calculation on 26 kyphotic PVCR patients. Using multiple linear measurements (mm), two angular approximations (°) were calculated: the geometric approximation (G°) using the geometric calculation (G-cal), and the rough approximation (R°) by more simplistic calculation (R-cal). Both G° and R° were compared against K° as measured on the pre- and postoperative radiographs. If calculated G° and R° is close to measured K°, we can use the calculations (G-cal and R-cal) in the clinical situation. ResultsThe mean correction of K° was 38°. K°−G° and K°−R° were not significantly greater than 3° and 6°, respectively. As K° was very close to G° and R°, K° can replace G° and R°. Therefore, we can use G-cal and R-cal in the clinical setting and we can determine how much posterior shortening and what cage size is required to obtain a certain amount of K°. ConclusionsWith two calculations (G-cal & R-cal), we can determine how much vertebral column shortening (mm) we need during PVCR to obtain the amount of kyphosis correction desired (K°). In order to obtain K°, using the formula deduced from G-cal and R-cal, we can determine the shortening between the upper and lower pedicle screws and cage size.

Pulmonary Function Improvement After Vertebral Column Resection for Severe Spinal Deformity

Retrospective review of prospectively accrued cohorts. We hypothesized that posterior-only vertebral column resection (PVCR) would result in improved postoperative pulmonary function, avoiding pulmonary insults from combined anterior/posterior approaches. Pulmonary function after PVCR for severe spinal deformity has not been previously studied. Previous studies have demonstrated impaired pulmonary performance after combined anterior/posterior fusions. Serial pulmonary function testing (PFTs) in 49 patients (27 pediatric, 22 adult) who underwent PVCR at a single institution was reviewed. Mean age at surgery was 28.7 years (range, 8-74 yr), and mean follow-up was 32 months (range, 23-64 mo). Thoracic PVCRs (T5-T11) were performed in 31 patients and thoracolumbar PVCRs (T12-L5) in 18 patients. Pediatric patients who underwent PVCR experienced both increased mean forced vital capacity (FVC) (2.10-2.43 L, P = 0.0005) and forced expiratory volume in 1 second (FEV1) (1.71-1.98 L, P = 0.001). There were no significant differences in percent-predicted values for FVC (69%-66%, P = 0.51) or FEV1 (64%-63%, P = 0.77). In adult patients, there were no significant changes in FVC (2.73-2.61 L, P = 0.35) or FEV1 (2.22-2.07 L, P = 0.51) after PVCR; also, changes in adult percent-predicted values for FVC (79%-76%, P = 0.47) and FEV1 (78%-74%, P = 0.40) were not significant. In pediatric patients who underwent PVCR, improved PFTs were correlated with younger age (P = 0.02), diagnosis of angular kyphosis (P ≤ 0.0001), no previous spine surgery (P = 0.04), and preoperative halo-gravity traction (P = 0.02). Comparison of PFT changes between patients who underwent PVCR and a control group who underwent combined anterior/posterior approaches revealed no significant differences. In pediatric patients, PVCR resulted in small but significant improvements in postoperative FVC and FEV1. In adult patients, no significant increases in PFTs were found. Patients who have the greatest potential for lung and thoracic cage growth after spinal correction are most likely to have improved pulmonary function after PVCR.

Matched Cohort Analysis of Posterior-Only Vertebral Column Resection Versus Combined Anterior/Posterior Vertebrectomy for Severe Spinal Deformity

Study DesignRetrospective matched cohort analysis. Summary of Background DataPosterior-only vertebral column resection (P-VCR) is a potential alternative to combined anterior/posterior vertebrectomy (A-P/VCR) for the treatment of severe spinal deformity. ObjectiveTo examine a matched cohort of adult and pediatric patients with severe spinal deformity treated with A/P-VCR versus P-VCR. MethodsDatabases of 2 spine surgeons at 1 institution from 1994 to 2007 were reviewed. Patients were matched based on age at surgery (within 10 years), diagnosis, curve pattern, vertebrae resected (within 1), levels of vertebrae resected (within 2), levels fused (within 5), and minimum 2-year follow-up. A total of 34 P-VCR patients were identified who appropriately matched 34 A/P-VCR patients. The etiology of the deformity and type of curve were matched directly so that they were identical for each matched pair. The remainder of the inclusion parameters was matched as closely as possible between the 2 groups according to the criteria listed above. ResultsFinal coronal Cobb correction P-VCR versus A/P-VCR showed that 52.6% versus 53.9% (p = .8) was similar, whereas P-VCR final sagittal Cobb correction was superior: 53.0% versus 40.0% (p = .017). The P-VCR group had a significantly shorter total operative time (p = .002) and total length of stay (p = .003). Complications rates were similar and relatively infrequent for both P-VCR and A/P-VCR, including wound infections requiring operative intervention, subsequent revision surgery, and transient motor deficits. Total Scoliosis Research Society scores improved from preoperative to final follow-up for both P-VCR (p = .007) and A/P-VCR (p = .07) groups. ConclusionsPosterior-only vertebral column resection is a challenging yet safe and effective means of treating severe scoliosis and/or kyphosis. Compared with an A/P-VCR for severe spinal deformity, P-VCR demonstrated shorter operative time and hospital stay, as well as improved sagittal correction and Scoliosis Research Society scores.

Posterior-only approach for lumbar vertebral column resection and expandable cage reconstruction for spinal metastases

The increasing incidence of spinal metastasis, a result of improved systemic therapies for cancer, has spurred a search for an alternative method for the surgical treatment of lumbar metastases. The authors report a single-stage posterior-only approach for resecting any pathological lumbar vertebral segment and reconstructing with a medium to large expandable cage while preserving all neurological structures. The authors conducted a retrospective consecutive case review of 11 patients (5 women, 6 men) with spinal metastases treated at 1 institution with single-stage posterior-only vertebral column resection and reconstruction with an expandable cage and pedicle screw fixation. For all patients, the indications for operative intervention were spinal cord compression, cauda equina compression, and/or spinal instability. Neurological status was classified according to the American Spinal Injury Association impairment scale, and functional outcomes were analyzed by using a visual analog scale for pain. For all patients, a circumferential vertebral column resection was achieved, and full decompression was performed with a posterior-only approach. Each cage was augmented by posterior pedicle screw fixation extending 2 levels above and below the resected level. No patient required a separate anterior procedure. Average estimated blood loss and duration of each surgery were 1618 ml (range 900-4000 ml) and 6.6 hours (range 4.5-9 hours), respectively. The mean follow-up time was 14 months (range 10-24 months). The median survival time after surgery was 17.7 months. Delayed hardware failure occurred for 1 patient. Preoperatively, 2 patients had intractable pain with intact lower-extremity strength and 8 patients had severe intractable pain, lower-extremity paresis, and were unable to walk; 4 of whom regained the ability to walk after surgery. Two patients who were paraplegic before decompression recovered substantial function but remained wheelchair bound, and 2 patients remained paraparetic after the surgery. No patients had lasting intraoperative neuromonitoring changes, and none died. Complications included 2 reoperations, 1 delayed hardware failure (cage subsidence that did not require revision), and 3 incidental durotomies (none of which required reoperation). No postoperative pneumonia, ileus, or deep venous thrombosis developed in any patient. A posterior-only approach for vertebral segment resection with preservation of spinal nerve roots is a viable technique that can be used throughout the entire lumbar spine. Extensive mobilization of the nerve roots is of utmost importance and allows for insertion and expansion of medium-sized, in situ expandable cages in the midline. This approach, although technically challenging, might reduce the morbidity associated with an anterior approach.

Posterior all-pedicle screw instrumentation combined with multiple chevron and concave rib osteotomies in the treatment of adolescent congenital kyphoscoliosis

Background contextCongenital kyphoscoliosis is a disorder that often requires surgical treatment. Although many methods of surgical treatment exist, posterior-only vertebral column resection with instrumentation and fusion seem to have become the gold standard for very severe and very rigid curves. Multiple chevron and concave rib osteotomies have been previously reported to be effective in the treatment of neglected severe idiopathic curves. We hypothesized that this method may also be used successfully in the treatment of congenital kyphoscoliosis. PurposeTo evaluate the effectiveness and safety of multiple chevron osteotomies combined with concave rib osteotomy and posterior pedicle screw instrumentation. Study designRetrospective chart review in the spine service of a large university hospital. Patient sampleAdolescent patients undergoing a specific surgical treatment for the indication of rigid congenital kyphoscoliotic deformity. Outcome measuresRadiographic images were used for the measurement of deformity correction. The Turkish version of the Scoliosis Research Society 22 (SRS-22) Patient Questionnaire has been used as a clinical outcome measure in the patient population. MethodsA retrospective chart review was performed. Patients admitted to Hacettepe Hospital Spine Center during the period of 2005 to 2009 were included. Criteria for inclusion were as follows: adolescent age group (10–16 years); congenital kyphoscoliosis; formation and/or segmentation defect of at least two vertebral motion segments; surgical treatment of deformity by posterior all-pedicle screw instrumentation, multiple chevron osteotomies, and multiple concave rib osteotomies; follow-up of at least 24 months; and a complete set of preoperative, postoperative, and follow-up standing posteroanterior and lateral full spinal radiographs. The patients' hospital records and X-rays were reviewed. Duration of surgery, intraoperative blood loss, postoperative transfusion requirements, postoperative stay in postanesthesia care unit (PACU), time of hospitalization, and complications were recorded. Deformity in both coronal and sagittal planes was analyzed for correction and maintenance of the correction in preoperative, postoperative, and follow-up radiographs. Patients' health-related quality of life was assessed using the SRS-22 questionnaire at the final follow-up. ResultsEighteen patients met the inclusion criteria. Their average age was 13.6 years (range, 11–16 years). Chevron osteotomies were performed at apical segments (three to seven levels) and concave rib osteotomies at Cobb-to-Cobb (five to eight levels). No patient had preoperative cord compression because of the sharply angulated deformity or neurologic deficit. The average preoperative scoliosis was 66.0° (range, 31°–116°), 52.4° (range, 22°–85°) on flexibility X-rays, and became 24.9° (range, 12°–52°) postoperatively. The average preoperative global kyphosis (T2–T12) of 75.9° (range, 50°–106°) became 49.5° (range, 18°–66°). The average preoperative local kyphosis of 71.9° (range, 35°–114°) became 31.4° (range, −44° to 64°). The average intraoperative bleeding was 989 cc, surgical time was 292 minutes, and intraoperative transfusion was 2.3 units. The maximum PACU stay was overnight. There were no neurologic complications except one pneumothorax and one pneumonia. The average follow-up was 34.3 months. At follow-up, average scoliosis was 27.5° (range, 10°–50°), global kyphosis was 50.3° (range, 28°–73°), and local kyphosis was 36.9°(range, −36° to 58°). Performed on the last follow-up, the average scores for the five domains of SRS-22 were 4.3, 4.4, 4.2, 4.1, and 4.8 for function, pain, self-image, mental health, satisfaction, and total, respectively. ConclusionsMultiple chevron and concave rib osteotomies with posterior instrumentation provide an acceptable rate of deformity correction and maintenance of correction at 2 years with acceptable intraoperative bleeding, surgical time, postoperative morbidity, and rate of complications. It can be considered as an alternative in the treatment of rigid congenital curves involving more than three levels or multiple curves separated by at least two segments that would otherwise require multiple vertebral resections.

Posterior Vertebral Column Resection for the Treatment of Dystrophic Kyphosis Associated With Type-1 Neurofibromatosis

Case report. To describe the use of posterior-only vertebral column resection and postoperative traction for spinal deformity associated with type-1 neurofibromatosis (NF1). Vertebral deformity, namely, thoracic scoliosis, is the predominant orthopedic manifestation of NF1. Patients may present with debilitating pain and rarely, myelopathy. The commonly dystrophic nature of these deformities makes them particularly recalcitrant to surgical correction. Traditionally, circumferential arthrodesis via combined anterior and posterior approaches has been recommended. Clinical and radiographical case review. A 14-year-old adolescent boy with NF1, severe cervicothoracic angular kyphosis, thoracic dislocation, and myelopathy presented status postmultiple anterior and posterior spinal fusions. The patient underwent posterior-only vertebral column resection after 6 weeks of halo-gravity traction. The surgery consisted of thoracic laminectomies, total corpectomies of T3 and T4, circumferential fusion, and posterior instrumentation from the occiput to T11. Autologous rib and iliac crest grafts were used as fusion substrate. Postoperatively, a halo vest was worn for 4 months to support the correction of his chin-on-chest deformity. The patient's neurological status returned to normal by 6 weeks postoperatively, and solid fusion was radiologically evident after 1 year. We think that posterior-only vertebral column resection represents a safe and efficacious but technically challenging option for the treatment of angular kyphotic spinal deformity and associated neurological deficit in patients with NF1.

Modified lateral extracavitary approach for vertebral column resection and expandable cage reconstruction of thoracic spinal metastases

Background:Spinal metastasis is common and can be associated with considerable morbidity. Vertebral resection and reconstruction have been shown to preserve neurological function and decrease pain. Most commonly, two-stage, combined anterior/posterior approaches are performed to surgically address significant vertebral metastasis. Recently, single-stage posterior approaches for vertebrectomies have been performed more often as a result of advances in instrumentation and anesthesia. The objective is to describe a series of patients with metastatic thoracic spine tumors who were treated using a modified, lateral extracavitary approach for a posterior-only vertebral column resection and expandable cage reconstruction.Methods:A retrospective analysis of 21 cases and 20 patients was performed.Results:The average estimated blood loss and length of surgery were 1700 ml (range, 200–7600 ml) and 6.8 h (range, 4–9 h), respectively. The mean follow-up was 14 months (range, 4–30 months). One patient had a permanent neurological deficit as a result of a postoperative hematoma. Of the five patients who were unable to walk prior to surgery, two regained the ability to ambulate. The total complication rate was 43% with majority being minor. A total of 94% of patients had durable preservation of the neurological function.Conclusion:The posterior approach for vertebral column resection and reconstruction is a viable alternative to the standard combined approach. We demonstrate the feasibility of performing the lateral extracavitary approach through a midline incision from T1 to T12. This less invasive approach continues to evolve as instrumentation becomes more advanced and possesses significant advantages in the oncologic setting.

Complications of one stage posterior vertebral column resection for the treatment of severe rigid spinal deformities

to summarize the complications of posterior vertebral column resection (pVCR) and pedicle screw fixation for the treatment of rigid thoracic and lumber spinal deformity. fifty four patients from a single center from February 2000 to February 2009 were included in this study. There were 23 males and 31 females with an average age of 28.3 years (range, 16-58 years). Patients were divided into 4 diagnostic categories: severe scoliosis (n = 9, mean Cobb angle, 91.7°), kyphoscoliosis (n = 22, mean scoliosis, 101.5°, and mean kyphosis, 69.4°), angular kyphosis (n = 21, mean kyphosis, 72.2°), global kyphosis (n = 2, mean kyphosis, 93.6°). All of the patients received one stage pVCR combined correction with pedicle screws and circumferential fusion. Radiographs and hospital charts were reviewed to analyze the outcomes of correction. a mean of 1.4 vertebral levels were resected, the mean operative time was 470 min, and the mean blood loss was 4180 ml. All the patients were followed-up for an average time of 26 months (range, 12 - 66 months). At the latest follow-up, the major curve correction averaged: severe scoliosis 61.4° (67%), kyphoscoliosis 59.7° (56%)/kyphosis 42.3° (59%), angular kyphosis 48.5° (71%), global kyphosis 62.7° (67%). A total of 21 complications (38.9%) occurred in 17 patients, including 5 (9.3%) neurological complications happened in early stage and one case of delayed complete paraplegic. There were 11 (20.4%) non-neurological complications happened in early stage and 5 (9.3%) cases in late stage. one stage posterior-only vertebral column resection can achieve satisfactory correction of severe deformities with limited flexibility. Given its technically demanding and exhausting features, its potential risk of significant complications should be paid more attention.

Posterior Vertebral Column Resection for VATER/VACTERL Associated Spinal Deformity: A Case Report

The VATER/VACTERL association is a syndrome notable for congenital vertebral malformations, anal atresia, cardiovascular anomalies, tracheoesophageal fistula, esophageal atresia, and renal or limb malformations. Vertebral malformations may include the entire spectrum of congenital spinal deformities, including kyphosis, as was seen in this case. A 14-year-old girl presented to our institution with severe rigid sagittal deformity in the thoracolumbar spine that had recurred following three prior spinal fusion surgeries: the first posterior only, the second anterior and posterior, and the third a posterior only proximal extension. These surgeries were performed to control progressive kyphosis from a complex failure of segmentation that resulted in a 66 degrees kyphosis from T11 to L3 by the time she was 9 years old. Our evaluation revealed solid arthrodesis from the most recent procedures with resultant sagittal imbalance, and surgical options to restore balance included anterior and posterior revision spinal fusion with osteotomies, multiple posterior extension osteotomies with circumferential spine fusion, and posterior vertebral column resection with circumferential spine fusion. She was advised that multiple posterior extension osteotomies would likely be insufficient to restore sagittal balance in the setting of solid arthrodesis from anterior and posterior surgery, and that the posterior-only vertebral column resection would provide results equivalent to revision anterior and posterior surgery, without the morbidity of the anterior approach. She successfully underwent posterior vertebrectomy and circumferential spinal fusion with instrumentation and is doing well 2 years postoperatively. Severe rigid sagittal deformity can be effectively managed with a posterior-only surgical approach, vertebrectomy, and circumferential spinal fusion with instrumentation.