J Korean Soc Spine Surg.  2001 Sep;8(3):219-225. 10.4184/jkss.2001.8.3.219.

Vertebral Column Resection through Posterior Approach in Rigid Adult Scoliosis

• Suk SI
• Kim JH
• Lee SM
• Jung ER
• Cho ST
• Lee SH
• Lee EY
• Lee JH

• KMID: 2209738
• DOI: http://doi.org/10.4184/jkss.2001.8.3.219

Abstract

OBJECTIVES
To report the surgical technique and effectiveness in treating rigid adult scoliosis with one stage vertebral column resection and pedicle screw fixation through a single posterior approach(PVCR).
MATERIALS AND METHODS
Twenty-one patients with low flexibility(less than 20~30%) subjected to PVCR were evaluated after a mean follow-up of 18.5 months(12~29 months). There were 10 males and 11 females. The mean age at the time of the operation was 32.1 years(19~61 years). Etiological diagnoses were idiopathic in 7, congenital in 12, neuromuscular in 2. Preoperatively, all the patients showed moderate to severe derangement of pulmonary function with reduced vital capacity(30%~57%).
RESULTS
An average of 1.3 vertebrae(1~3 vertebrae) were removed. The resection of body was in thoracic in 12 and lumbar in 15. Posterior fusion was carried out in 6.8(3~12) levels. Following the surgery, preoperative thoracic scoliosis of 86degree(55~130degree) and lumbar scoliosis of 64degree( 35~110degree) were corrected to 38degree(15~65degree) and 25degree(14~61degree), showing a correction of 56.2%(39~78%) and 61.1% (44~82%) respectively. Preoperative kyphosis of 59degree(16~104degree) was corrected to 24degree(2~58degree), showing a correction of 60.2%(41~74%). Preoperative coronal imbalance and shoulder height difference was corrected to 0.6 cm and 1.0 cm respectively. The average operation time and transfusion were 253 minutes and 2835 ml. The complications comprised two transient neurological deficits, one aggravated neurological deficits, one monoparesis, one infection, and one pneumothorax.
CONCLUSIONS
One stage posterior vertebral column resection is a promising new technique for rigid scoliosis, significantly reducing the operative time and morbidity of combined anterior-posterior resection.

Keyword

Adult scoliosis; Posterior vertebral column resection; Pedicle screw fixation

MeSH Terms

Adult*
Diagnosis
Female
Follow-Up Studies
Humans
Kyphosis
Male
Operative Time
Paresis
Pneumothorax
Scoliosis*
Shoulder
Spine*

Figure

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  Fig. 1. Schematic diagram of PVCR(posterior vertebral column resection).

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  Fig. 2. PVDR(resection of lamina, pedicle, vertebrol body, disc and end plate).

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  Fig. 3. Deformity correction was carried out by compression and shortening of the vertebral column for each additional attempt of increasing the correction.

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  Fig. 4. A 41-years old male with severe thoracic scoliosis (116˚) and trunk imbalance. After T8 vertebra including upper and lower discs were resected, cage was inserted for anterior support. Postoperatirely, thoracic curver was corrected to 55˚ with satisfactory trunk balance.

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  Fig. 5. Same patient with thoracic kyphosis of 120 degrees on lateral scanogram. Following PVCR, kyphosis was improved to 40 degrees with excellent sagittal balance.

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  Fig. 6. Preoperative and postoperative medical photos.

Reference

1). Boachie-Adjei O, Bradford DS. Vertebral column resection and Arthrodesis for complex spinal deformities. J Spinal Disord. 4:193–202. 1991.

2). Bradford DS. Adult scoliosis: Current concepts of treatment. Clin Orthop. 229:70–87. 1988.

3). Bradford DS. Vertebral column resection. Orthop Trans. 11:502. 1987.

4). Bradford DS, Boachie-Adjei O. One-stage anterior and posterior hemivertebral resection and arthrodesis for congenital scoliosis. J Bone Joint surg(Am). 72:536–40. 1990.

5). Bradford DS, Tribus CB. Current concepts and management of patients with fixed decompensated spinal deformity. Clin Orthop. 306:64–72. 1994.

6). Bradford DS, Tribus CB. Vertebral column resection for the treatment of rigid coronal decompensation. Spine. 22(14):1590–1599. 1997.

7). Cummine JL, Lonstein JE, Moe JH, Winter RB, Bradford DS. Reconstructive surgery in the adult for failed scoliosis fusion. J Bone Joint Surg. 61:1151–61. 1979.

8). Dewald RL. Osteotomy of the thoracic lumbar spine. In, Bradford DS, editor. The spine. Volume in Master Techniques in Orthopaedic Surgery Series. Philadelpia: Lippincott-Raven Publishers;1997.

9). Dick J, Boachie-Adjei O, Wilson M. One-Stage versus two-stage anterior and posterior spinal reconstruction in adults: Complication of outcomes including nutritional status, complication rates, hospital costs, and other factors. Spine. 17:S310–6. 1992.

10). Floman Y, Micheli Lj. Combined anterior and Posterior fusion in spinal deformed patients. Clin Orthop. 164:110–22. 1982.

11). Holte DC, Winter RB, Lonstein JE, Denis F. Excision of hemivertebra and wedge resection in the treatment of congenital scoliosis. J Bone Joint Surg(Am). 77:159–71. 1995.

12). Johnson JF, Holt RT. Combined use of anterior and posterior surgery for adult scoliosis. Orthop Clin. North Am. 19:361–70. 1988.

13). Keith H. Bridwell., Ronald L. Dewald. Vertebral Column Resection for Severe Deformities. The Textbook of Spinal Surgery, second edition, vol. 2. 2227–2230.

14). Kostuik JP, Maurais GR, Richardson WJ, Okajima Y. Combined single stage anterior and posterior osteotomy for correction of iatrogenic lumbar kyposis. Spine. 13(3):257–266. 1988.

15). Lackum HE, Smith AD. Removal of vertebral bodies in the treatment of scoliosis. Surgery, Gynecology and Obstetrics. 57:250–256. 1933.

16). Leatherman KD, Dickson RA. Two-stage corrective surgery for congenital deformities of the spine. J Bone Joint Surg(Br). 61:324–328. 1979.

17). Lehmer SM, Keppler L, Biscup RS, Enker P, Miller SD and steffee ad. Posterior transvertebral osteotomy for adult thoracolumbar kyphosis. Spine. 19(18):2060–2067. 1994.

18). Luque ER. Vertebral column transposition. Orthop Trans. 7:29. 1983.

19). MacLennan A. Scoliosis. Br Med J. 2:865–6. 1922.

20). Nuber GW, Schafer MF. Surgical management of adult scoliosis. Clin Orthop. 208:228–37. 1986.

21). Se-Il Suk. Spinal Surgery. 374-382:1997.

22). Se-Il Suk, Jin-Hyok Kim, Won-jung Kim, Sang-Min Lee. Vertebral Column Resection through Postreior Approach in Lumbosacral Kyphosis. Journal of Korean Society of spine Surgery. Vol. 5:No.(2):307–313. 1998.

23). Sponseller PD, Cohen MS, Nachemson AL, Hall JE, Wohl MEB. Results of surgical treatment of adults with idiopathic scoliosis. J Bone Joint Surg(Am). 69:667–75. 1987.

24). Steven R. Garfin and Alexander R. Vaccaro. Adult Idiopathic and Degenerative Scoliosis. Orthopaedic Knowledge Update: spine. 1977.

25). Swank S, Lonstein JE, Moe JH, Winter RB, Bradford DS. Surgical treatment of adult scoliosis. J Bone Joint Surg(Am). 63:268–87. 1981.

26). Von Lckum HL, Smith ADF. Removal of vertebral bodies in the treatment of scoliosis. Surg Gynecol. 57:250–6. 1933.

27). Wiles P. Rescection of dorsal vertebrae in congenital scoliosis. J Bone Joint Surg(Am). 33:151–4. 1951.