J Korean Neurosurg Soc.  2018 Mar;61(2):251-257. 10.3340/jkns.2017.0181.

Clinical and Radiological Outcomes of Posterior Vertebral Column Resection for Severe Spinal Deformities

• Lee BH
• Hyun SJ
• Kim KJ
• Jahng TA
• Kim YJ
• Kim HJ

• KMID: 2408027
• DOI: http://doi.org/10.3340/jkns.2017.0181

Abstract

OBJECTIVE
The aim of this study was to investigate clinical and radiological outcomes of patients who underwent posterior vertebral column resection (PVCR) by a single neurosurgeon in a single institution.
METHODS
Thirty-four consecutive patients with severe spinal deformities who underwent PVCR between 2010 and 2016 were enrolled. The radiographic measurements included a kyphotic angle of PVCR levels (VCR angle), sagittal vertical axis (SVA), thoracic kyphosis, lumbar lordosis (LL), and spinopelvic parameters. The data of surgical time, estimated blood loss, duration of hospital stay, complications, intraoperative neurophysiologic monitoring, and the Scoliosis Research Society (SRS)-22 questionnaire were collected using a retrospective review of medical records.
RESULTS
The VCR angle, LL, and SVA values were significantly corrected after surgery. The VCR and LL angle were changed from the average of 38.4±32.1° and −22.1±39.1° to −1.7±29.4° (p < 0.001) and −46.3±23.8° (p=0.001), respectively. The SVA was significantly reduced from 103.6±88.5 mm to 22.0±46.3 mm (p=0.001). The clinical results using SRS-22 survey improved from 2.6±0.9 to 3.4±0.8 (p=0.033). There were no death and permanent neurological deficits after PVCR. However, complications occurred in 19 (55.9%) patients. Those patients experienced a total of 31 complications during- and after surgery. Sixteen reoperations were performed in twelve (35.3%) patients. The incidence of transient neurological deterioration was 5.9% (two out of 34 patients).
CONCLUSION
Severe spinal deformities can be effectively corrected by PVCR. However, the PVCR technique should be utilized limitedly because surgery-related serious complications are relatively common.

Keyword

Posterior; Vertebral column; Resection; Deformity; Complication

MeSH Terms

Animals
Congenital Abnormalities*
Humans
Incidence
Intraoperative Complications
Kyphosis
Length of Stay
Lordosis
Medical Records
Neurophysiological Monitoring
Neurosurgeons
Operative Time
Retrospective Studies
Scoliosis
Spine*

Figure

• 

  Fig. 1 An 11-year-old boy who suffered from early onset scoliosis. The left side rib hump was noted at preoperative clinical features (A and B). The preoperative postero-anterior (C) and lateral (D) radiographs showed severe kyphoscoliosis of more than 100 degrees and prior arthrodesis at T11–L1. The patient has received an apical PVCR at T11–L1, and posterior spinal fusion from T8 to L5 with multiple rods construct. The correction of coronal and sagittal alignment maintained well on the clinical pictures (E and F) and radiographs (G and H) six months after surgery. PVCR : posterior vertebral column resection.

Reference

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