Vertebral column decancellation for the management of sharp angular spinal deformity

Abstract

The management goal of sharp angular spinal deformity is to realign the spinal deformity and safely decompress the neurological elements. However, some shortcomings related to current osteotomy treatment for these deformities are still evident. We have developed a new spinal osteotomy technique—vertebral column decancellation (VCD), including multilevel vertebral decancellation, removal of residual disc, osteoclasis of the concave cortex, compression of the convex cortex accompanied by posterior instrumentation with pedicle screws, with the expectation to decrease surgical-related complications. From January 2004 to March 2007, 45 patients (27 males/18 females) with severe sharp angular spinal deformities at our institution underwent VCD. The diagnoses included 29 congenital kyphoscoliosis and 16 Pott’s deformity. Preoperative and postoperative radiographic evaluation was performed. Intraoperative, postoperative and general complications were noted. For a kyphosis deformity, an average of 2.2 vertebrae was decancellated (range, 2–4 vertebrae). The mean preoperative kyphosis was +98.6° (range, 82°–138°), and the mean kyphosis in the immediate postoperative period was +16.4° (range, 4°–30°) with an average postoperative correction of +82.2° (range, 61°–124°). For a kyphoscoliosis deformity, the correction rate was 64% in the coronal plane (from 83.4°–30.0°) postoperatively and 32.5° (61% correction) at 2 years’ follow-up. In the sagittal plane, the average preoperative curve of 88.5° was corrected to 28.6° immediately after surgery and to 31.0° at 2 years’ follow-up. All patients had solid fusion at latest follow-up. Complications were encountered in eight patients (17.8%), including CSF leak (n = 1), deep wound infection (n = 1), epidural hematoma (n = 1), transient neurological deficit (n = 4), and complete paralysis (n = 1). The results of this study show that single-stage posterior VCD is an effective option to manage severe sharp angular spinal deformities.

Cervical compensatory alignment changes following correction of adult thoracic deformity: a multicenter experience in 57 patients with a 2-year follow-up

“…3 Application of the 3CO techniques, specifically VCR and PSO, for thoracic deformity correction has been described elsewhere. 12,16,28,29 In this cohort of 38 patients, significant reciprocal improvements in cervical parameters were again absent, but as regards the lumbar parameters, there was -7.8° in LL. The explanation for the lack of reciprocal change in CL remains unclear.…”

The risk factors of neurologic deficits of one-stage posterior vertebral column resection for patients with severe and rigid spinal deformities

“…In recent years, the reports on its clinical application have been gradually increasing [1][2][3][4][5][6][7][8][9]. In particular, to severe (the Cobb [1008), angular and rigid (flexibility \10 %) spinal deformities that are considerably decompensatory at the coronal or sagittal plane, PVCR may be the best choice [1].…”

Asymmetric T5 Pedicle Subtraction Osteotomy (PSO) for complex posttraumatic deformity

“…The posterior vertebral column resection (PVCR), performed in a single approach, allows an excellent correction of the sagittal plane deformity. However, PVCR appears to be a hazardous procedure, with the risk of extensive blood loss and neurologic impairment [3].…”