Short-term X-ray Results of Posterior Vertebral Column Resection in Severe Congenital Kyphosis, Scoliosis, and Kyphoscoliosis

Abstract

Study Design. Retrospective case series. Objective. To analyze the efficacy and safety of posterior vertebral column resection performed on a consecutive series of patients with severe congenital spinal deformity. Summary of Background Data. The treatment of severe congenital spinal deformities is a demanding and difficult surgical challenge. Conventional procedures, such as posterior and anterior instrumentation or combined anteroposterior instrumentation provide limited correction in rigid neglected or maltreated (fused) deformities. Methods. Forty-four patients with severe deformity and managed by posterior vertebral column resection between years 1997 and 2007 having more than 2 years of follow-up were included. Mean age was 8 (range, 2-28) years at the time of operation. The hospital charts were reviewed for demographic data and etiology of deformity. Measurements of curve magnitude and balance were made on 36-in. standing anteroposterior and lateral radiographs obtained before surgery and at most recent follow-up to assess deformity correction, spinal balance, complications related to the instrumentation, and any evidence of pseudarthrosis. Results. Preoperative coronal plane major curve of 106 degrees (range, 90 degrees-132 degrees) with flexibility of less than 30% was corrected to 41.4 degrees (range, 20 degrees-72 degrees), showing a 61% scoliosis correction at the final follow-up. Coronal imbalance was improved by 79% at the most recent follow-up assessment. Preoperative thoracic kyphosis of 87 degrees (range, 67 degrees-103 degrees) in patients with kyphosis was corrected to 36 degrees range, 25 degrees-48 degrees) at the most recent follow-up evaluation. Lumbar lordosis of 27 degrees (range, 8 degrees-35 degrees) in patients with hypolordotic deformity was corrected to 45 degrees. Complications included postoperative infection in 2 patients, dural laceration in 2 patients, and hemopneumothorax in 1 patient. Conclusion. Posterior vertebral column resection is an effective technique providing a successful correction of stiff complex congenital deformities. However, it is a technically demanding procedure, with possible risks for major complications.