Vertebral Column Resection for Rigid Spinal Deformity

Saifi, Comron; Laratta, Joseph L.; Petridis, Petros; Shillingford, Jamal N.; Lehman, Ronald A.; Lenke, Lawrence G.

doi:10.1177/2192568217699203

Cited by 51 publications

(39 citation statements)

References 30 publications

(76 reference statements)

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“…Dobbs et al 29 reported no statistically significant differences between the groups for a large-curve AIS .908 treated with posterior spinal fusion and with a combined anterior-posterior spinal fusion with same correction rate of 44%. Shi et al 30 also revealed there was no statistically significant difference between sever rigid scoliosis patients treated with the posterior only approach with an all 1 430 210 3 1 -2 840 280 5 2 -3 520 180 3 1 -4 450 205 3 1 -5 600 190 4 1 -6 590 260 4 1 Transient urinary retention 7 790 290 5 2 -8 810 290 5 2 SIADH 9 460 240 3 1 -10 520 200 3 1 -11 620 250 32 reported 50% to 70% correction in severe rigid coronal or sagittal malalignment after vertebral column resection, but the technique was associated with significant morbidity. Lenke et al 33 reported on PVCR in a series of 35 patients for severe pediatric spinal deformity, with an average preoperative scoliosis of 1158 (798-1508) corrected to 618 (51%).…”

Section: Discussionmentioning

confidence: 97%

Outcome of Posterior-Only Approach for Severe Rigid Scoliosis: A Retrospective Report

2020

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Background: The management of severe scoliosis may lead to significant complications, and adequate mobilization is a key step to achieve maximal correction, usually requiring extensive approaches. There is still no consensus on the management of these severe and rigid curves. In this study we evaluated the clinical and radiologic outcome of a posterior-only approach with multilevel asymmetric Ponte osteotomy with a minimum of 2 years' followup.Methods: In this retrospective study, 23 patients with severe and rigid adolescent idiopathic scoliosis who underwent surgery with a single-staged posterior-only approach were included. The surgical procedures in these patients were excision of posterior ligaments and spinous process, partial laminectomy in caudal part of lamina, excision of the ligamentum flavum, facetectomies, and multilevel asymmetric posterior column osteotomies (Ponte) followed by instrumented fusion. Clinical records-including demographic data; operating time; hospitalization time; blood loss; number of segments instrumented, fused, and osteotomized; functional improvement; follow-up duration; and complications-were recorded.Results: The mean preoperative Cobb angle of major curve in coronal plan was 97.58 (range, 828-1318) with the mean flexibility of 21.48 (range, 108-258) on bending radiography. The mean immediate postoperative Cobb angle of major curve was 34.88 (range, 178-618), showing a 64.2% correction. The mean preoperative coronal and sagittal imbalances of 3.8 and 4.2 cm were improved to 1.0 and 1.3 cm at postoperative measurements, respectively. A mean of 6.1 (range, 5-9) vertebral segments were osteotomized. We experienced no major complications.Conclusions: We found that a posterior-only procedure in patients with severe and rigid adolescent idiopathic scoliosis could provide correction rate, coronal and sagittal balance, and clinical outcomes comparable with other procedures. Using this technique can eliminate the need for the anterior release, with the associated complications related to anterior surgery, in the treatment of severe rigid scoliosis.

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Section: Discussionmentioning

confidence: 97%

Outcome of Posterior-Only Approach for Severe Rigid Scoliosis: A Retrospective Report

2020

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“…PVCR provides a greater amount of correction than all other types of spinal osteotomies and allows translational and rotational correction of the vertebral column, but it is much more aggressive due to its more complicated mechanisms, higher technical difficulties and increased technical demands. 13,21 Twelve patients with posttraumatic kyphosis, with a mean local angle of 64.1±6.3° (Range, 55.3-75.2°), were included in our study with a mean follow up period of 13.5±2 (Range, [12][13][14][15][16][17][18] months. All the patients were treated with PVCR of the kyphotic vertebra.…”

Section: Discussionmentioning

confidence: 99%

Posterior Vertebral Column Resection in Management of Severe Post-traumatic Thoracolumbar Kyphosis

Naggar

Elgawhary

Elhewala

2018

Egyptian Spine Journal

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Background Data: Thoracolumbar fractures nowadays are considered the commonest spinal fractures and its treatment remains one of the major controversies. Post-traumatic kyphosis (PTK) is considered the commonest serious complication of poorly managed thoracolumbar fractures which can affect the patient health quality of life. Different corrective osteotomy techniques are described to correct this deformity but with limited correction in sever angular kyphotic deformity. Our hypothesis was, among several osteotomies described to correct kyphosis, vertebral column resection (VCR) provides the highest angle of correction required to manage patients with severe PTK.Purpose: To evaluate the safety and efficacy of posterior VCR in the treatment of patients with severe degrees of post-traumatic thoracolumbar kyphosis and determine the degree of correction in sagittal imbalance and its relationship with functional outcome of the patients. Study Design: This prospective clinical case study. Patients and Methods: Twelve patients suffering from PTK and managed with posterior VCR were recruited for this study. The mean local kyphosis angle (LKA) was 64.1±6.3 ᴼ . Outcome measures were Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) and radiological using local kyphosis angle (LKA), global kyphosis (GK), lumbar lordosis (LL) and sagittal vertical axis (SVA). The mean follow up time was 13.5±2 months.Results: The mean LKA and SVA score improved from 64.1± 6.3 o and 52.6±8.3mm preoperatively to 8.8±3.4 o and 13.1±4.8mm postoperatively, respectively. All were statistically significant. Functionally, the VAS score of back pain significantly reduced from 6.8±0.9 to 1.7±0.8 and the Oswestry Disability Index significantly improved from 59.8±7.5 to 11.6±3.4. No major complications were reported apart from intraoperative dural tear in 2 patients, superficial infection in one patient, deep infection in one patient and temporary paraparesis in one patient.Conclusion: Posterior VCR can provide satisfactory correction in severe PTK and improvement in functional outcome with appropriate application and fine surgical technique. (2018ESJ165)

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“…Единственным способом радикальной коррекции тяжелого кифоза при запущенной врожденной деформации представляется VCR, предполагающая полное удаление позвонков на вершине кифотической дуги и последующее соединение верхнего и нижнего сегментов позвоночника металлоконструкцией [14,20,22]. Одномоментное значительное изменение геометрии позвоночного канала несет существенный риск: общая частота неврологических осложнений достигает 11,6 % [22], причем в некоторых сериях наблюдений исход в перманентную нижнюю параплегию составил 3 % [17].…”

Section: к линический с лу чайunclassified

“…Одномоментное значительное изменение геометрии позвоночного канала несет существенный риск: общая частота неврологических осложнений достигает 11,6 % [22], причем в некоторых сериях наблюдений исход в перманентную нижнюю параплегию составил 3 % [17]. Операция характеризуется большой ожидаемой кровопотерей [14,22] и высокой вероятностью несостоятельности металлоконструкции: 2,9 % больных в дальнейшем нуждаются в проведении ревизионных вмешательств [17]. Решение выполнить корригирующую вертебротомию у неврологически интактного пациента должно быть строго взвешенным и обоснованным.…”

Section: к линический с лу чайunclassified

Surgical treatment of advanced congenital kyphoscoliosis: A case report

et al. 2018

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Clinical case of surgical treatment of advanced congenital kyphoscoliosis in 12 years old child is reported. Radiographs and CT at presentation failed to reveal the entire anomaly. By analysis of priorly made radiographs hemivertebra L1 was recognized. At genitourinary assessment L-shaped kidney was detected. A full-size 3D-printed model was used for surgical planning. Vertebral column resection as treatment option was discussed, but due to high neurologic complication rate this approach was refused. After preoperative 35 days halo-femoral traction anterior instrumented fusion was performed. Right ureter was stented for intraoperative urologic injury prevention. Scoliosis correction of 32% and kyphosis of 14% was achieved. 5 months later definitive posterior uninstrumented fusion was performed. Spinal deformities caused by vertebral malformations progress dramatically unless they are treated early. An advanced case is a clinical challenge because of technical difficulties and poor result. Vertebral column resection is a treatment option for severe kyphoscoliosis, but it’s indications should be strictly individualized. Preoperative halo-femoral traction is the most safe correction method in spinal deformity due to prolonged and gradual action. 3d-printed models are practical for surgical planning. The model may be used intraoperatively as a 3D-reference. In congenital scoliosis genitourinary system should be assessed meticulously, and urologist advice in relevant case is necessary.

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Vertebral Column Resection for Rigid Spinal Deformity

Cited by 51 publications

References 30 publications

Outcome of Posterior-Only Approach for Severe Rigid Scoliosis: A Retrospective Report

Outcome of Posterior-Only Approach for Severe Rigid Scoliosis: A Retrospective Report

Posterior Vertebral Column Resection in Management of Severe Post-traumatic Thoracolumbar Kyphosis

Surgical treatment of advanced congenital kyphoscoliosis: A case report

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