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

Clinical article

Jingming Xie M.D., Yingsong Wang M.D., Zhi Zhao M.D., Ying Zhang M.D., Yongyu Si M.D., Tao Li M.D., Zhendong Yang M.D., and Luping Liu M.D.
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  • Department of Orthopaedics, Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, People's Republic of China
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Object

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.

Methods

The authors retrospectively reviewed their experience with 28 patients with extremely severe (Cobb angles in the coronal or sagittal plane > 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°]).

Results

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).

Conclusions

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.

Abbreviation used in this paper:PVCR = posterior vertebral column resection.

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Contributor Notes

Address correspondence to: Jingming Xie, M.D., Department of Orthopaedics, Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, People's Republic of China. email: xiejingming@vip.163.com.

Please include this information when citing this paper: published online October 12, 2012; DOI: 10.3171/2012.9.SPINE111026.

  • 1

    Attenello FJ, , McGirt MJ, , Atiba A, , Gathinji M, , Datoo G, & Weingart J, : Suboccipital decompression for Chiari malformation-associated scoliosis: risk factors and time course of deformity progression. J Neurosurg Pediatr 1:456460, 2008

    • Search Google Scholar
    • Export Citation
  • 2

    Böhm H, , Harms J, , Donk R, & Zielke K: Correction and stabilization of angular kyphosis. Clin Orthop Relat Res 258:5661, 1990

  • 3

    Bridwell KH: Decision making regarding Smith-Petersen vs. pedicle subtraction osteotomy vs vertebral column resection for spinal deformity. Spine (Phila Pa 1976) 31:19 Suppl S171S178, 2006

    • Search Google Scholar
    • Export Citation
  • 4

    Bridwell KH, , Lewis SJ, , Rinella A, , Lenke LG, , Baldus C, & Blanke K: Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance. Surgical technique. J Bone Joint Surg Am 86-A:Suppl 1 4450, 2004

    • Search Google Scholar
    • Export Citation
  • 5

    Dobbs MB, , Lenke LG, , Kim YJ, , Luhmann SJ, & Bridwell KH: Anterior/posterior spinal instrumentation versus posterior instrumentation alone for the treatment of adolescent idiopathic scoliotic curves more than 90 degrees. Spine (Phila Pa 1976) 31:23862391, 2006

    • Search Google Scholar
    • Export Citation
  • 6

    Gertzbein SD, & Harris MB: Wedge osteotomy for the correction of posttraumatic kyphosis. A new technique and a report of three cases. Spine (Phila Pa 1976) 17:374378, 1992

    • Search Google Scholar
    • Export Citation
  • 7

    Hankinson TC, , Klimo PJ Jr, , Feldstein NA, , Anderson RC, & Brockmeyer D: Chiari malformations, syringohydromyelia and scoliosis. Neurosurg Clin N Am 18:549568, 2007

    • Search Google Scholar
    • Export Citation
  • 8

    Kato S, , Kawahara N, , Tomita K, , Murakami H, , Demura S, & Fujimaki Y: Effects on spinal cord blood flow and neurologic function secondary to interruption of bilateral segmental arteries which supply the artery of Adamkiewicz: an experimental study using a dog model. Spine (Phila Pa 1976) 33:15331541, 2008

    • Search Google Scholar
    • Export Citation
  • 9

    Kawahara N, , Tomita K, , Baba H, , Kobayashi T, , Fujita T, & Murakami H: Closing-opening wedge ostectomy to correct angular kyphotic deformity by a single posterior approach. Spine (Phila Pa 1976) 26:391402, 2001

    • Search Google Scholar
    • Export Citation
  • 10

    Kawahara N, , Tomita K, , Kobayashi T, , Abdel-Wanis ME, , Murakami H, & Akamaru T: Influence of acute shortening on the spinal cord: an experimental study. Spine (Phila Pa 1976) 30:613620, 2005

    • Search Google Scholar
    • Export Citation
  • 11

    Kawahara N, , Tomita K, , Murakami H, & Demura S: Total en bloc spondylectomy for spinal tumors: surgical techniques and related basic background. Orthop Clin North Am 40:4763, vi, 2009

    • Search Google Scholar
    • Export Citation
  • 12

    Kim YJ, , Lenke LG, , Bridwell KH, , Kim KL, & Steger-May K: Pulmonary function in adolescent idiopathic scoliosis relative to the surgical procedure. J Bone Joint Surg Am 87:15341541, 2005

    • Search Google Scholar
    • Export Citation
  • 13

    Lehmer SM, , Keppler L, , Biscup RS, , Enker P, , Miller SD, & Steffee AD: Posterior transvertebral osteotomy for adult thoracolumbar kyphosis. Spine (Phila Pa 1976) 19:20602067, 1994

    • Search Google Scholar
    • Export Citation
  • 14

    Lenke LG, , O'Leary PT, , Bridwell KH, , Sides BA, , Koester LA, & Blanke KM: Posterior vertebral column resection for severe pediatric deformity: minimum two-year follow-up of thirty-five consecutive patients. Spine (Phila Pa 1976) 34:22132221, 2009

    • Search Google Scholar
    • Export Citation
  • 15

    Lenke LG, , Sides B, , Koester L, , Hensley M, & Blanke KM: Surgical technique: vertebral column resection (VCR) for severe pediatric and adult spinal deformity. Presented at the Scoliosis Research Society 42nd Annual Meeting Edinburgh, SRS, 2007. (Abstract)

    • Search Google Scholar
    • Export Citation
  • 16

    Lenke LG, , Sides BA, , Koester LA, , Hensley M, & Blanke KM: Vertebral column resection for the treatment of severe spinal deformity. Clin Orthop Relat Res 468:687699, 2010

    • Search Google Scholar
    • Export Citation
  • 17

    Macagno AE, & O'Brien MF: Thoracic and thoracolumbar kyphosis in adults. Spine (Phila Pa 1976) 31:19 Suppl S161S170, 2006

  • 18

    Matsumoto M, , Watanabe K, , Tsuji T, , Ishii K, , Takaishi H, & Nakamura M, : Progressive kyphoscoliosis associated with tethered cord treated by posterior vertebral column resection: a case report. Spine (Phila Pa 1976) 34:E965E968, 2009

    • Search Google Scholar
    • Export Citation
  • 19

    Newton PO, , Perry A, , Bastrom TP, , Lenke LG, , Betz RR, & Clements D, : Predictors of change in postoperative pulmonary function in adolescent idiopathic scoliosis: a prospective study of 254 patients. Spine (Phila Pa 1976) 32:18751882, 2007

    • Search Google Scholar
    • Export Citation
  • 20

    Newton PO, , Wenger DR, , Mubarak SJ, & Meyer RS: Anterior release and fusion in pediatric spinal deformity. A comparison of early outcome and cost of thoracoscopic and open thoracotomy approaches. Spine (Phila Pa 1976) 22:13981406, 1997

    • Search Google Scholar
    • Export Citation
  • 21

    O'Shaughnessy BA, , Koski TR, & Ondra SL: Reversal of neurologic deterioration after vertebral column resection by spinal cord untethering and duraplasty. Spine (Phila Pa 1976) 33:E50E54, 2008

    • Search Google Scholar
    • Export Citation
  • 22

    Raw DA, , Beattie JK, & Hunter JM: Anaesthesia for spinal surgery in adults. Br J Anaesth 91:886904, 2003

  • 23

    Ruf M, & Harms J: Posterior hemivertebra resection with transpedicular instrumentation: early correction in children aged 1 to 6 years. Spine (Phila Pa 1976) 28:21322138, 2003

    • Search Google Scholar
    • Export Citation
  • 24

    Ruf M, , Jensen R, , Letko L, & Harms J: Hemivertebra resection and osteotomies in congenital spine deformity. Spine (Phila Pa 1976) 34:17911799, 2009

    • Search Google Scholar
    • Export Citation
  • 25

    Song KS, , Chang BS, , Yeom JS, , Lee JH, , Park KW, & Lee CK: Surgical treatment of severe angular kyphosis with myelopathy: anterior and posterior approach with pedicle screw instrumentation. Spine (Phila Pa 1976) 33:12291235, 2008

    • Search Google Scholar
    • Export Citation
  • 26

    Steinmetz MP, , Rajpal S, & Trost G: Segmental spinal instrumentation in the management of scoliosis. Neurosurgery 63:3 Suppl 131138, 2008

    • Search Google Scholar
    • Export Citation
  • 27

    Suh SW, , Modi HN, , Yang J, , Song HR, & Jang KM: Posterior multilevel vertebral osteotomy for correction of severe and rigid neuromuscular scoliosis: a preliminary study. Spine (Phila Pa 1976) 34:13151320, 2009

    • Search Google Scholar
    • Export Citation
  • 28

    Suk SI, , Kim JH, , Kim WJ, , Lee SM, , Chung ER, & Nah KH: Posterior vertebral column resection for severe spinal deformities. Spine (Phila Pa 1976) 27:23742382, 2002

    • Search Google Scholar
    • Export Citation
  • 29

    Xie J, , Li T, , Wang Y, , Zhao Z, , Zhang Y, & Bi N: Change in Cobb angle of each segment of the major curve after posterior vertebral column resection (PVCR): a preliminary discussion of correction mechanisms of PVCR. Eur Spine J 21:705710, 2012

    • Search Google Scholar
    • Export Citation
  • 30

    Xie J, , Wang Y, , Zhao Z, & Zhang Y: The safe placement of upper and middle thoracic pedicle screws in pediatric deformity. J Spinal Disord Tech 24:5559, 2011

    • Search Google Scholar
    • Export Citation
  • 31

    Xie J, , Wang Y, , Zhao Z, , Zhang Y, , Si Y, & Yang Z, : One-stage and posterior approach for correction of moderate to severe scoliosis in adolescents associated with Chiari I malformation: is a prior suboccipital decompression always necessary?. Eur Spine J 20:11061113, 2011

    • Search Google Scholar
    • Export Citation
  • 32

    Xie J, , Zhao Z, , Wang Y, , Zhang Y, , Li T, & Yang Z, : Freehand transpedicular screw placement in the process of applying posterior vertebral column resection to treat severe spinal deformity. Presented at the Scoliosis Research Society 18th International Meeting on Advanced Spine Techniques Copenhagen 2011. (Abstract)

    • Search Google Scholar
    • Export Citation
  • 33

    Xie JM, , Wang YS, , Zhang Y, , Lu N, , Chen H, & Cao J, : [Posterior total vertebral resection correct rigid kyphosis or kyphoscoliosis: clinical report of initial stage.]. J Spinal Surg 6:14, 2008. (Chinese)

    • Search Google Scholar
    • Export Citation

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