Revision Versus Primary Patients Undergoing Vertebral Column Resection for Severe Spinal Deformities

• Published in: Spine deformity 2014-09, Vol.2 (5), p.350-357
• Main Authors: Oshima, Yasushi, MD, PhD, Lenke, Lawrence G., MD, Koester, Linda, BS, Takeshita, Katsushi, MD, PhD
• Format: Article
• Language: English
• Subjects: Case Studies; Complication rates; Medicine & Public Health; Orthopedics; Primary surgery; Revision surgery; Severe spinal deformity; Vertebral column resection
• ISSN: 2212-134X; 2212-1358
• DOI: 10.1016/j.jspd.2014.06.001

Abstract Study Design Retrospective comparative study. Objectives To compare correction rates and complications of revision versus primary patients undergoing vertebral column resection (VCR). Summary of Background Data Although an all-posterior VCR has obviated the need for a circumferential approach, it is technically demanding, especially in a revision setting. Methods Between 2002 and 2009, 55 revision patients underwent a posterior-only VCR. Diagnoses included severe scoliosis (n = 3), kyphoscoliosis (KS) (n = 29), global kyphosis (GK) (n = 13), and angular kyphosis (AK) (n = 10). Radiographic findings and complications were compared with 38 primary patients who underwent a VCR during the same period. All patients had a minimum 2-year follow-up (range, 2–6 years). Results The mean number of VCR levels were 1.6 in revision versus 1.2 in primary cases (p = .005). In the severe scoliosis and KS groups, major coronal curve correction was 48% in revision versus 63% in primary cases (p = .001). In the KS, GK, and AK groups, the major sagittal curve correction was 52% in revision versus 57% in primary cases (p = .27). Preoperative (p = .015) and postoperative (p = .002) sagittal imbalance was significantly greater in the revision group. There were no spinal cord–related complications, but 7 revision (13%) and 3 primary (8%) patients temporarily lost neuromonitoring data or failed wakeup tests; however, none had a permanent neurological deficit. Six revision patients (11%) required further revision surgery due to implant failure (3), progressive sagittal or coronal imbalance (2), and delayed deep wound infection (1) versus only 1 primary patient (3%) due to increased coronal imbalance. Preoperative and postoperative Scoliosis Research Society scores were not significantly different between groups. Conclusions Vertebral column resections in revision patients may be more technically demanding than in primary patients but can be performed safely in conjunction with intraoperative spinal cord monitoring. Revision and primary patients undergoing a VCR showed improved clinical outcomes.