A single posterior approach for multilevel modified vertebral column resection in adults with severe rigid congenital kyphoscoliosis: a retrospective study of 13 cases

Abstract

We report a multilevel modified vertebral column resection (MVCR) through a single posterior approach and clinical outcomes for treatment of severe congenital rigid kyphoscoliosis in adults. Transpedicular eggshell osteotomies and vertebral column resection are two techniques for the surgical treatment of rigid severe spine deformities. The authors developed a new technique combining the two surgical methods as a MVCR, through a single posterior approach, for surgical treatment of severe congenital rigid kyphoscoliosis in adults. Thirteen adult patients with severe rigid congenital kyphoscoliosis deformity were treated by a single posterior approach using a MVCR technique. The surgery processes included a onestage posterior transpedicular eggshell technique first, and then expanded the eggshell technique to adjacent intervertebra space through abrasive reduction of the vertebral cortices from inside out. All posterior vertebral elements were removed including the cortical vertebral bone around the neural canal. Range of resection of the vertebral column at the apex of the deformity included apical vertebra and both cephalic and/or caudal adjacent wedged vertebrae. Totally, 32 vertebrae had been removed in 13 patients, with 2.42 vertebrae being removed on average in each case. The average fusion extent was 7.69 vertebrae. Mean operation time was 266 min with average blood loss of 2,411.54 ml during operation. Patients were followed up for an average duration of 2.54 years. Deformity correction was 59% in the coronal plane (from 79.7°to 32.4°) postoperatively and 33.7°(57% correction) at 2 years followup. In the sagittal plane, correction was from preoperative 85.9°to 27.5°immediately after operation, and 32.0°at 2 years follow-up. Postoperative pain was reduced from preoperative 1.77 to 0.54 at 2 years follow-up in visual analog scale. SRS-24 scale was from 38.2 preoperatively to 76.9 at 2 years follow-up postoperative. Complications were encountered in four patients (30.7%) with transient neurology that spontaneously improved without further treatment within 3 months. MVCR technique through a single posterior approach is an effective procedure for the surgical treatment of severe congenital rigid kyphoscoliosis in adults.

Posterior-only multilevel modified vertebral column resection for extremely severe Pott’s kyphotic deformity

“…However, the remaining select situations of PVCR still cannot provide adequate correction. In these special cases, we have known that this posterior-only multilevel MVCR described by the senior author has been performed satisfactorily in the past, and most cases restored nearly normal sagittal profile [18]. In this study, the spinal sagittal Konstam's angle was corrected from a preoperative kyphosis 100.3°to a postoperative angle of 15.9°(p = 0.001) and with a mean correction of 84.1%.…”

“…The key steps of MVCR technique are summarized as follows [18]: (1) at the start, the posterior structure, such as spinous processes and lamina were left intact to minimize the blood loss. (2) Once the transpedicular process was completed, a 5-mm burr was used for decancellation through the pedicle.…”

Personalised modified osteotomy using computer-aided design–rapid prototyping to correct thoracic deformities

“…Then, the eggsell technique was performed to decancellate through the pedicle stump. This is different from the conventional eggshell technique [22] and the modified vertebral column resection (MVCR) technique reported by Wang et al [25]. Using our model, the spinal cord and nerve roots can be visualised and protected to avoid injury.…”

Osteotomies in the posterior-only treatment of complex adult spinal deformity: a comparative review

“…Reported operative times have ranged from 266 to 577 minutes, and blood loss has ranged from 691 to 2810 ml for this technique. 26,41,45 Regarding complications, in a series of 70 patients, Suk et al 41 found a 34.3% overall rate of complications and a 17.1% rate of neurological complications was encountered, including 2 complete cord injuries (albeit in patients with preexisting neurological deficits), 6 hematomas with cauda equina syndrome requiring reoperation, 4 nerve root injuries, and 5 fixation failures. For these reasons, Suk noted, "Theoretically very appealing, the vertebral column resection is, in fact, a challenging procedure and is an ordeal for both the patient and the surgeon, requiring an exhaustively lengthy operation with a great risk of major complications at every turn en route."…”

“…In a study in children, Lenke et al 26 found a similar 40% overall rate of complications as well as an 11.4% rate of neurological complications; however, half occurred intraoperatively and were noted during osteotomy closure with loss of monitoring data, allowing for reparative measures that prevented subsequent deficits, thereby highlighting the importance of neuromonitoring during these cases. Finally, a recent study by Wang et al 45 reported on 13 adults with severe rigid kyphoscoliosis who underwent a modified combined multilevel eggshell osteotomy and pVCR. These authors found a 30.7% rate of complications and a 15% rate of temporary neurological complications.…”