Posterior vertebral column resection for correction of rigid spinal deformity curves greater than 100°

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>The surgical treatment of severe and rigid spinal deformities poses difficulties and dangers. In this article, the authors summarize their surgical techniques and evaluate patient outcomes after performing posterior vertebral column resection (PVCR) for the correction of spinal deformities with curves greater than 100°, and investigate the crucial points to ensure neurological safety during this challenging procedure.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>The authors retrospectively reviewed their experience with 28 patients with extremely severe (Cobb angles in the coronal or sagittal plane &gt; 100°) and rigid thoracic or thoracolumbar spine deformities who underwent PVCR. The average patient age was 20.2 years and all patients underwent a minimum follow-up of 24 months (range 24–60 months). Patients were divided into groups according to their morphological classification as follows: kyphosis alone (Group A, 6 patients with a mean Cobb angle of 109.0° [range 105°–120°]); kyphoscoliosis with coronal plane curves notably greater than sagittal plane curves (Group B, 14 patients with mean scoliotic curves of 116.6° [range 102°–170°] and kyphotic curves of 77.7° [range 42°–160°]); and kyphoscoliosis with sagittal curves notably greater than coronal plane curves (Group C, 8 patients with a mean coronal curve of 85.4° [range 65°–110°] and a mean sagittal curve of 117.6° [range 102°–155°]).</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>A total of 36 vertebrae were removed in 28 patients who had a severe rigid spinal deformity, and the mean fusion extent was 13.3 vertebrae (range 7–17 vertebrae). The mean operating time was 620 minutes (range 320–920 minutes) with an average operative blood loss of 6,680 ml (range 3,000–24,000 ml). The overall final correction rate of scoliosis was 59.0%, and average postoperative kyphotic Cobb angles ranged from 30.4° to 95.9°. In Group A the mean preoperative sagittal angle of 109.0° was corrected to a mean postoperative angle of 32.0°. In the Group B kyphoscoliotic patients, the correction rate in the coronal plane was 58.6%; the Cobb angle in the sagittal plane was corrected from a mean of 77.7° preoperatively to 25.1° postoperatively; in Group C, the correction rate in the coronal plane was 58.5%, and the mean sagittal angle was reduced from a mean of 117.6° preoperatively to 39.0°. Of the 28 patients who underwent PVCR, 46 complications were observed in 18 patients intra- and postoperatively. There were 5 neurological complications including 1 case of late-onset paralysis and 4 cases of thoracic nerve root pain, all of which resolved during the early follow-up period. Nonneurological complications occurred more often in kyphoscoliotic patients (41 complications). The mean follow-up of all patients was 33.7 months (range 24–60 months).</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Posterior vertebral column resection was effective in correcting severe rigid spinal deformity, although the procedure was technically demanding, exhaustingly lengthy, and was associated with a variety of complications. The PVCR technique created a space for spinal correction and spinal cord tension adjustment and the correction could be performed under direct inspection and by palpation of the tension in the spinal cord through the space. Therefore, in terms of the spinal cord, the deformity correction process involved in the PVCR procedure is relatively safe.</jats:p></jats:sec>

Surgical Treatment of Congenital Scoliosis Associated With Tethered Cord by Thoracic Spine-shortening Osteotomy Without Cord Detethering

“…5 , 8 , 9 Complications in patients who were treated by VCR for scoliosis have ranged from 17.9% to 40.3%. [16][17][18] In our study, the complication rate was 23.8%, which is similar to the 2 procedures taken separately. We therefore conclude that spine-shortening osteotomy is a safe alternative to traditional strategies for the treatment of congenital scoliosis associated with tethered cord.…”

“…without a tethered cord. [16][17][18] In addition, we found that the sagittal vertical axis was around 1.4 ± 0.9 cm before surgery. It remained stable after surgery at 1.3 ± 0.8 cm at the immediate postoperative assessment and 1.2 ± 1.0 cm at the last follow-up.…”

Posterior vertebral column resection in spinal deformity: a systematic review

“…Seven studies were excluded for insufficient number of patients (less than 10 patients) and one study was excluded due to the fact that the ''modified PVCR'' was performed. Seventeen studies from seven institutions [7,[9][10][11][13][14][15][16][17][18][19][20][21][22][23][24][25] were included for further analysis. To avoid overlap of patients in different studies, only one main publication from each institution was retained.…”

Changes in CSF flow after one-stage posterior vertebral column resection in scoliosis patients with syringomyelia and Chiari malformation Type I

“…In our experience, this technique creates a space for spinal correction and spinal cord tension adjustment, and the correction can be performed under direct inspection and by palpation of the tension in the spinal cord through the space. 26 During the procedure, the focus of the correction process is on the spinal cord, which is protected from excessive tension and stretching by the shortening of the spinal column. Following posterior vertebral column resection, the tension of the spinal cord at the craniocervical junction was decreased in our patients, and abnormal CSF flow was indirectly improved.…”

“…The procedure was performed as previously reported 26 and included resection of the os seous elements posterior and anterior to one or more spinal segments as well as the upper and lower vertebral discs adjacent to the segments. This created sufficient space in which correction and reconstruction could be performed.…”