Posterior Vertebral Column Resection for Severe Rigid Scoliosis

Suk, Se-Il; Chung, Ewy-Ryong; Kim, Jin-Hyok; Kim, Sung‐Soo; Lee, Jeong-Seop; Choi, Won-Kee

doi:10.1097/01.brs.0000170590.21071.c1

Cited by 314 publications

(255 citation statements)

References 16 publications

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“…Having two osteotomy sites rather than one single site means the amount of correction needed at each site is less, potentially decreasing the incidence of spinal cord kinking. The 66% coronal Cobb angle correction we achieved in this series compares well with the results of series using posterior-only vertebral column resection (51-59%) [5,12].…”

Section: Discussionsupporting

confidence: 76%

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Surgical treatment of severe congenital scoliosis with unilateral unsegmented bar by concave costovertebral joint release and both-ends wedge osteotomy via posterior approach

Qingsong

Zhou

et al. 2011

Eur Spine J

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Introduction Congenital scoliosis with unilateral unsegmented bar has remained a surgical challenge. If it is treated with a traditional release of the convex side and an apical wedge osteotomy, there is a risk of bony bridge fracture on the concave side and spine translation during correction maneuvers, which may then result in spinal cord injuries. The authors developed a technique that consists of a concave-side costovertebral joint release followed by both-ends wedge osteotomy via a posterior-only approach. In this article, we describe the technique in detail, and present the results of ten patients treated with this technique. Methods A total of ten patients with congenital scoliosis with unilateral unsegmented bar, who had undergone a concave-side costovertebral joint release followed by both-end wedge osteotomy via a posterior-only approach were followed up for a mean of 34 months (range 26-48 months). The radiographic parameters and clinical records were all reviewed and analyzed. Results Body height increased by a mean of 7.3 cm (range 6.0-9.0 cm). The preoperative coronal Cobb angle was 102°(range 83°-139°) with a mean flexibility of 14%. At the most recent follow-up visit, the mean Cobb angle was 35°(range 12°-53°) and the mean correction rate was 66%. The coronal imbalance improved from 3.4 cm (range 0.8-6.3 cm) preoperatively to 1.1 cm (range 0.6-1.8 cm) postoperatively, a 67% correction. There were no definite pseudarthroses, no implant failure, and no obvious loss of correction in the follow-up period. Complications included one patient with hemopneumothorax and another patient with incomplete paralysis of the left lower extremity caused by a pedicle screw violating the spinal canal at the T5 level. The screw was removed 4 h after the initial operation, and the patient fully recovered after 3 months. Conclusion We have had good results with our technique of concave-side costovertebral joint release and both-end wedge osteotomy. It has the advantage of remnant anulus fibrosus, the ligamentum flavum, and the facet joints on the concave side serving both as a hinge and to minimize translation of the spine ends. It can provide excellent threedimensional curve correction for patients with severe rigid congenital scoliosis with unilateral unsegmented bar.

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Section: Discussionsupporting

confidence: 76%

“…Suk et al [12] described the technique of posterior-only vertebral column resection. In his series of 16 patients with a mean preoperative Cobb angle of 109°, the post-operative Cobb angle was 46°(59% correction).…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment of severe congenital scoliosis with unilateral unsegmented bar by concave costovertebral joint release and both-ends wedge osteotomy via posterior approach

Qingsong

Zhou

et al. 2011

Eur Spine J

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“…The operative or nonoperative treatments often fail, resulting in a three-dimensional deformity at coronal, sagittal, and frontal planes [2,16,29,30]. In contrast to the adolescent scoliosis, which is usually asymptomatic, the adult scoliosis patients usually present with back pain [34,38].…”

Section: Discussionmentioning

confidence: 99%

“…For rigid kyphoscoliosis ([75°in sagittal plane), VCR (including PVCR) and eggshell methods are the most popular techniques at present. Vertebrectomy was first illustrated in 1922 by MacLennan, who demonstrated an apical resection from a posterior-only approach with postoperative casting for the treatment of severe scoliosis [29]. However, most of the patients had complications of nerve injuries and infection, which showed poor results.…”

Section: Discussionmentioning

confidence: 99%

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

Wang

Zhang

et al. 2008

Eur Spine J

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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.

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“…Vertebral column resections (VCRs) are one option but carry a high rate of neurologic complications and are technically demanding for most surgeons [8,9]. We presumed the VEPTR might offer these patients improved cosmesis with low neurologic risk.…”

Section: Introductionmentioning

confidence: 99%

The Usefulness of VEPTR in the Older Child With Complex Spine and Chest Deformity

Samdani

Hilaire

Emans

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Posterior Vertebral Column Resection for Severe Rigid Scoliosis

Abstract: PVCR is an effective alternative for severe rigid scoliosis. It is a highly technical procedure and should only be performed by an experienced surgical team.

Cited by 314 publications

References 16 publications

Surgical treatment of severe congenital scoliosis with unilateral unsegmented bar by concave costovertebral joint release and both-ends wedge osteotomy via posterior approach

Surgical treatment of severe congenital scoliosis with unilateral unsegmented bar by concave costovertebral joint release and both-ends wedge osteotomy via posterior approach

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

The Usefulness of VEPTR in the Older Child With Complex Spine and Chest Deformity

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