Posterior only vertebral column resection for the treatment of severe spinal deformities in pediatric patients, a retrospective case series

• Published in: World neurosurgery 2017-05, Vol.101, p.425-430
• Main Authors: Schroeder, Malte, M.D, Viezens, Lennart, M.D, Kunkel, Philip, M.D, Ridderbusch, Karsten, M.D, Hissnauer, Tim Nicolas, M.D, Jungesblut, Oliver Dirk, M.D, Hoffmann, Michael, M.D, MBA, Rueger, Johannes Maria, M.D, Stuecker, Ralf, M.D
• Format: Article
• Language: English
• Subjects: Adolescent; Child; Child, Preschool; Female; Follow-Up Studies; Humans; Kyphosis - diagnostic imaging; Kyphosis - surgery; Male; Neurosurgery; Neurosurgical Procedures - methods; Pediatric spine; Retrospective Studies; Revision surgery; Scoliosis - diagnostic imaging; Scoliosis - surgery; Severity of Illness Index; Spinal Fusion - methods; Treatment Outcome; Vertebral column resection
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2017.01.118

Objective The treatment of severe spinal deformities in pediatric patients is very challenging. Posterior only vertebral column resection (PVCR) allows for correcting of severe deformities of the vertebral column via a posterior only procedure. We analyzed radiological outcome of PVCR performed on a series of pediatric patients with severe congenital and acquired spinal deformities. Methods A case series of eleven pediatric patients with severe spinal deformity who were treated by PVCR between 2009 and 2013 were retrospectively analyzed. All patients had posterior instrumentation and reconstruction of the anterior column with titanium cages filled with autologous bone. Seven patients had pure kyphosis or kyphoscoliosis while four patients were treated due to scoliotic deformities. The patient records were reviewed for demographic and general clinical data. Complications and adverse events, transfusion rates and surgical time were recorded. Radiological analysis included Cobb-angles and percentage of correction, analysis of sagittal profile, time to fusion and possible complications related to instrumentation. Results Average preoperative scoliosis of 61° was corrected to 32° resulting in a 50% correction at final follow-up. Coronal imbalance was improved to 36% at the most recent follow-up. Mean preoperative kyphotic deformity was 90° and was corrected to 43° at the last follow-up evaluation. Intraoperative complications included loss of the neuromonitoring signals in two cases and pleural laceration in one case. Conclusions PVCR for children is an effective and safe technique providing a successful correction of complex pediatric spinal deformities. Nevertheless, it remains a technically highly demanding procedure, implying the possibility of severe complications.