Posterior vertebral column resection in spinal deformity: a systematic review

Yang, Changsheng; Zheng, Zhaomin; Liu, Hui; Wang, Jianru; Kim, Yongjung Jay; Cho, Samuel K.

doi:10.1007/s00586-015-3767-7

Cited by 94 publications

(101 citation statements)

References 40 publications

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“…in this technique, the intraoperative estimated blood loss is generally around 3000-5000 mL, and the mean operative time is 9.3 h [16] . For spine deformity, PSO and VCR are classic techniques and can achieve satisfactory results.…”

Section: Discussionmentioning

confidence: 99%

Protection of L1 nerve roots in parallel endplate osteotomy for severe rigid thoracolumbar spine deformity

Liao

Miao

Xie

et al. 2020

Preprint

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Background: This is a retrospective study of the use of parallel endplate osteotomy (PEO) for correction of severe rigid thoracolumbar spine deformity. Methods : From July 2016 to June 2017, 10 patients with severe rigid thoracolumbar spine deformity underwent PEO on T12 or L1 vertebrae were studied. Results : Following PEO at T12 or L1, the mean kyphosis and scoliosis correction rates reached 77.4± 8.5% and 76.6± 6.8%, respectively and the intraoperative estimated blood loss was 1990±1010 mL, and the mean operative time was 7.12± 3.88 h. The SF-36 scores of physical function, role-physical, bodily pain, general health, vitality, social function, role-emotional and mental health changed from 60 ± 30, 47 ± 33, 44 ± 30, 32 ± 18, 50 ±30, 46 ± 29, 26 ± 40 and 52 ± 20 at baseline to 81 ± 16, 69 ± 19, 73 ± 11, 66 ± 21, 74 ± 16, 74 ± 24, 63 ± 37 and 76 ± 12 one year after surgery, respectively (P < 0.01). Three patients had symptoms of L1 nerve root injury, as reflected by lower limb weakness and inner thigh numbness on knee extension and hip flexion, which was further confirmed by electromyography. Conclusions : PEO is easier to operate, and the spinal cord and nerve root are under direct vision and can effectively and safely correct severe rigid thoracolumbar spine deformity with satisfactory clinical results. However, it is important to identify, separate and protect L1 nerve roots during surgery in cases where patients have symptoms of back pain, muscle weakness and leg numbness on the convex side after surgery.

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Section: Discussionmentioning

confidence: 99%

Protection of L1 nerve roots in parallel endplate osteotomy for severe rigid thoracolumbar spine deformity

Liao

Miao

Xie

et al. 2020

Preprint

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“…[35][36][37][38] According to the results of the present study, correction rates of the main curve with PVCR were similar to those reported in previous studies of the technique. A systematic review of PVCR for correcting spinal deformity by Yang et al 41 reported a scoliosis correction rate of the main curve of 61.2%. Ozturk et al 30 reported a main scoliotic curve correction of 62% for PVCR in the treatment of patients with severe congenital kyphosis, scoliosis, or kyphoscoliosis.…”

Section: Discussionmentioning

confidence: 99%

Congenital scoliosis treated with posterior vertebral column resection in patients younger than 18 years: longer than 10-year follow-up

Chang

Yang

Lee

et al. 2016

SPI

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OBJECTIVE There have been no reports on the long-term radiographic outcomes of posterior vertebral column resection (PVCR) in patients with congenital scoliosis. The purpose of this study was to evaluate the surgical outcomes and complications after PVCR and its long-term effects on correcting this deformity in children with congenital scoliosis. METHODS The authors retrospectively analyzed the medical records of 45 patients with congenital scoliosis who were younger than 18 years at the time of surgery and who underwent PVCR and fusion with pedicle screw fixation (PSF). The mean age of the patients at the time of surgery was 11.3 years (range 2.4–18.0 years), and the mean length of follow-up was 12.8 years (range 10.1–18.2 years). RESULTS The mean Cobb angle of the main curve was 46.5° before PVCR, 13.7° immediately after PVCR, and 17.6° at the last follow-up. For the compensatory cranial curve, PVCR corrected the preoperative Cobb angle of 21.2° to 9.1° postoperatively and maintained it at 10.9° at the last follow-up. For the compensatory caudal curve, the preoperative Cobb angle of 23.8° improved to 7.7° postoperatively and was 9.8° at the last follow-up. The authors noted 22 complications, and the overall incidence of complications was 48.9%. CONCLUSIONS Posterior vertebral column resection is an effective procedure for managing congenital scoliosis in patients younger than 18 years. Use of PVCR and fusion with PSF for congenital scoliosis achieved rigid fixation and satisfactory deformity correction that was maintained over the long term. However, the authors note that PVCR is a technically demanding procedure and entails risks for major complications and excessive blood loss.

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“…Единственным способом радикальной коррекции тяжелого кифоза при запущенной врожденной деформации представляется VCR, предполагающая полное удаление позвонков на вершине кифотической дуги и последующее соединение верхнего и нижнего сегментов позвоночника металлоконструкцией [14,20,22]. Одномоментное значительное изменение геометрии позвоночного канала несет существенный риск: общая частота неврологических осложнений достигает 11,6 % [22], причем в некоторых сериях наблюдений исход в перманентную нижнюю параплегию составил 3 % [17]. Операция характеризуется большой ожидаемой кровопотерей [14,22] и высокой вероятностью несостоятельности металлоконструкции: 2,9 % больных в дальнейшем нуждаются в проведении ревизионных вмешательств [17].…”

Section: к линический с лу чайunclassified

“…Одномоментное значительное изменение геометрии позвоночного канала несет существенный риск: общая частота неврологических осложнений достигает 11,6 % [22], причем в некоторых сериях наблюдений исход в перманентную нижнюю параплегию составил 3 % [17]. Операция характеризуется большой ожидаемой кровопотерей [14,22] и высокой вероятностью несостоятельности металлоконструкции: 2,9 % больных в дальнейшем нуждаются в проведении ревизионных вмешательств [17]. Решение выполнить корригирующую вертебротомию у неврологически интактного пациента должно быть строго взвешенным и обоснованным.…”

Section: к линический с лу чайunclassified

Surgical treatment of advanced congenital kyphoscoliosis: A case report

et al. 2018

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Clinical case of surgical treatment of advanced congenital kyphoscoliosis in 12 years old child is reported. Radiographs and CT at presentation failed to reveal the entire anomaly. By analysis of priorly made radiographs hemivertebra L1 was recognized. At genitourinary assessment L-shaped kidney was detected. A full-size 3D-printed model was used for surgical planning. Vertebral column resection as treatment option was discussed, but due to high neurologic complication rate this approach was refused. After preoperative 35 days halo-femoral traction anterior instrumented fusion was performed. Right ureter was stented for intraoperative urologic injury prevention. Scoliosis correction of 32% and kyphosis of 14% was achieved. 5 months later definitive posterior uninstrumented fusion was performed. Spinal deformities caused by vertebral malformations progress dramatically unless they are treated early. An advanced case is a clinical challenge because of technical difficulties and poor result. Vertebral column resection is a treatment option for severe kyphoscoliosis, but it’s indications should be strictly individualized. Preoperative halo-femoral traction is the most safe correction method in spinal deformity due to prolonged and gradual action. 3d-printed models are practical for surgical planning. The model may be used intraoperatively as a 3D-reference. In congenital scoliosis genitourinary system should be assessed meticulously, and urologist advice in relevant case is necessary.

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Posterior vertebral column resection in spinal deformity: a systematic review

Abstract: PVCR is a powerful surgical procedure for severe spinal deformity. However, it has the risk of excessive blood loss and major complications. Decision of PVCR should be prudent and the procedure should be performed by an experienced surgical team.

Cited by 94 publications

References 40 publications

Protection of L1 nerve roots in parallel endplate osteotomy for severe rigid thoracolumbar spine deformity

Protection of L1 nerve roots in parallel endplate osteotomy for severe rigid thoracolumbar spine deformity

Congenital scoliosis treated with posterior vertebral column resection in patients younger than 18 years: longer than 10-year follow-up

Surgical treatment of advanced congenital kyphoscoliosis: A case report

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