Early outcomes and complications of posterior vertebral column resection

• Published in: The spine journal 2015-05, Vol.15 (5), p.983-991
• Main Authors: Papadopoulos, Elias C., MD, Boachie-Adjei, Oheneba, MD, Hess, W. Fred, MD, Sanchez Perez-Grueso, Francisco J., MD, Pellisé, Ferran, MD, Gupta, Munish, MD, Lonner, Baron, MD, Paonessa, Kenneth, MD, Faloon, Michael, MD, Cunningham, Matthew E., MD, PhD, Kim, Han Jo, MD, Mendelow, Michael, MD, Sacramento, Christina, MD, Yazici, Muharrem, MD
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Congenital; Decompression, Surgical - adverse effects; Decompression, Surgical - methods; Female; Humans; Kyphosis; Male; Middle Aged; Monitoring, Intraoperative; Neurosurgical Procedures - adverse effects; Neurosurgical Procedures - methods; Orthopedic Procedures - adverse effects; Orthopedic Procedures - methods; Orthopedics; Posterior vertebral column resection; Postinfectious; PVCR; Radiography; Retrospective Studies; Scoliosis - diagnostic imaging; Scoliosis - surgery; Spine - diagnostic imaging; Spine - surgery; Treatment Outcome
• ISSN: 1529-9430; 1878-1632
• DOI: 10.1016/j.spinee.2013.03.023

Abstract Background context Hyperkyphosis confers a significant risk for neurologic deterioration as well as compromised cardiopulmonary function. Posterior vertebral column resection (PVCR) is a challenging but effective technique for spinal cord decompression and deformity correction that even under the setting of limited resources can be performed to reduce the technical difficulties, the operating time, and possibly the complications of the traditional two-staged vertebral column resection (VCR). Purpose To report on the results of VCR performed through a single posterior approach (PVCR) in the treatment of severe rigid kyphosis in a series of patients treated and followed at a Scoliosis Research Society Global Outreach Program site in West Africa. Study design Retrospective case series. Patient sample Forty-five consecutive patients treated with PVCR for correction of severe rigid kyphosis. Outcome measures Clinical and radiographic outcomes and complications; Scoliosis Research Society outcome instrument (SRS-22). Methods From 2002 to 2009, 45 patients (20 male and 25 female) underwent PVCR for kyphosis from congenital deformity (nine) or secondary to tuberculosis of the spine (36). Preoperative demographics, preop and postop neurologic status, SRS-22 scores and complications were recorded; upright full spine X-rays were available in all patients. Mean age was 14 years (6–47 years); mean follow-up 27 months (2–79 months). Mean preoperative kyphosis measured 108°. The deformity apex was resected via a costotransverse (thoracic) or posterolateral (lumbar) approach; neurosurveillance with sensory (somatosensory-evoked potentials) and motor (motor-evoked potentials) potential was used in all cases. Posterior instrumentation was used in all patients, and anterior structural cage was used in 32 patients. Results Intraoperative monitoring changes occurred in 10 patients (22%), and one patient progressed to complete spinal cord injury. Average preoperative local kyphosis was 108° and corrected to 600 postoperatively. Postoperatively, no additional patient showed neurologic deterioration; of the 11 patients with preoperative gait disturbances, 4 improved to normal gait, 5 remained the same, and 2 showed deterioration of their walking ability to nonambulating level. Total SRS-22 scores improved from 3.18 to 3.54 (p=.01), primarily self-image domain. Conclusions Posterior vertebral column resection was successfully undertaken for the management of thoracic and