Posterior Vertebral Column Resection in Severe Spinal Deformities A Total of 102 Cases
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Study Design. Retrospective case series. Objective. To analyze the efficacy and safety of posterior vertebral column resection (PVCR) performed to a consecutive series of patients with severe spinal deformity and managed by PVCR. Summary of Background Data. The treatment of severe spinal deformities is a demanding and difficult surgical challenge. Conventional procedures such as posterior and anterior instrumentation or combined anteroposterior instrumentation afford limited correction in rigid neglected or maltreated (fused) deformities. Methods. A total of 102 consecutive patients with severe deformity and managed by PVCR between years 1996 and 2007 having more than 2 years follow-up were included. Mean age was 37.6 (range = 2-84 years) 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-inch standing anteroposterior and lateral radiographs taken 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 102 degrees (range = 80 degrees-29 degrees) with flexibility of less than 30% was corrected to 38.3 degrees (range = 20 degrees-72 degrees) showing a 62% scoliosis correction at the final follow-up. Coronal imbalance was improved 72% at the most recent follow-up assessment. Preoperative thoracic kyphosis of 83 degrees (range = 65 degrees-104 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 25 degrees (range = 8 degrees-35 degrees) in patients with hypolordotic deformity was corrected to 42 degrees. Two patients had nerve root palsies not identified during the surgery and healed completely in 6 months after surgery. Conclusion. PVCR is an effective technique because it is a spinal column shortening procedure and it allows to do correction in same session. However, it is a technically demanding procedure with possible risks for major complications.