The efficacy and complications of one stage posterior vertebral column resection for severe spinal deformities

Objective To evaluate the outcomes and complications of posterior vertebral column resection in the treatment of severe and fixed spinal deformities. Methods From January 2008 to January 2010,15 consecutive cases (4 males, 11 females) of severe and fixed spinal deformities managed by single posterior vertebral column resection with transpedicular instrumentation were investigated retrospectively. The diagnosis included congenital scoliosis in 10 cases, adolescent idiopathic scoliosis in 1 case, congenital kyphosis in 3 cases, tuberculous kyphosis 1 case. Radiograghs were measured to determine the regional coronal and sagittal curve magnitude, and the coronal and sagittal balance preoperatively, postoperatively and at the final follow-up. Operative reports and patient charts were reviewed to record operation time, introoperative blood loss and complications. Results The mean resected vertebrae was 1.8 ( range, 1-5). The mean operation time was 331 min (range, 240-450 min) with an average blood loss of 1453 ml (range, 800-3000 ml). The average follow-up time was 13 months (range, 3-24 months). The regional scoliosis was corrected from 111° to 51°with a correction rate of 54. 0%, and regional kyphosis from 104° to 39° with a correction rate of 62.5%. No obvious loss of correction was noted at the final follow-up. The coronal trunk shift improved from 19. 5 mm preoperatively to 18. 1 mm postoperatively and 12. 4 mm at final follow-up. The sagittal balance improved from 20. 0 mm preoperatively to - 2. 0 mm postoperatively and - 1. 1 mm at the final follow-up. Complications included partial pleural rupture requiring repair in 3 cases, transient muscle weakness of one lower limb after surgery but recovered completely at 6 month follow-up in 2 cases, and tightness of thorax after surgery in one case. Conclusions Posterior vertebral column resection is effective in treatment of severe and rigid spinal deformities. But it is a technique-demanding procedure with higher risks of major neurologic complications. Key words: Scoliosis; Kyphosis; Osteotomy; Operative approach