2007 Award Winners

Paper #13
Hibbs Award Nominee for Best Clinical Presentation

Posterior Vertebral Column Resection (VCR) for Severe Pediatric and Adult Spinal Deformity: Indications, Results, and Complications of 43 Consecutive Cases

Lawrence G. Lenke, MD; Brenda A. Sides, MA; Ms. Ms. Linda Koester; Marsha Hensley, RN; Kathy Blanke, RN

Introduction: The ability to treat severe pediatric and adult spinal deformity through an all-posterior vertebral column resection (VCR) approach has obviated the need for a circumferential approach in primary and revision settings. Our purpose was to examine indications, correction rates, and complications of these challenging procedures.

Methods: Between 2002 and 2006, 43 consecutive patients underwent a posterior-only VCR for severe scoliosis (S) (n=7, mean 102˚, range 63˚-150˚); global kyphosis (GK) (n=12, mean 92˚, range 81˚-134˚; angular kyphosis (AK) (n=10, mean 77˚, range 43˚-135˚); or kyphoscoliosis (K+S) (n=14, mean total K+S 198˚, range 149˚-275˚) by a single surgeon. There were 30 pediatric (ave. age 13, range 4-18), and 13 adult (ave. age 52, range 40-74) patients with 23 primary and 20 revision cases. All patients underwent a 1-level (n=24), 2-level (n=15), or 3-level (n=4) VCR utilizing pedicle screws, anteriorly positioned cages (n=31), and intraop spinal cord monitoring (NMEPs & SSEPs). 39 out of 43 (90%) were performed at L1 or cephalad in spinal cord (SC) territory; the remainder were in the upper cauda equina (L2 and/or L3).

Results: The major curve correction was 73˚(72%) for the S cases, 46˚(50%) for the GK cases, 55˚(71%) for the AK cases, and a combined 115˚(58%) for the K+S cases. 7 patients (18%) lost intraoperative NMEP data during correction with data returning to baseline following prompt surgical intervention. All patients following surgery were at their baseline (n=40) or showed improved SC function (n=3), while no one worsened. 2 patients had nerve root palsies postop (unilateral quad deficit in a revision L2 & L3 VCR, unilateral foot drop in a revision T12 & L1 VCR with preop 4/5 strength) resolving spontaneously 6 months/2 weeks respectively. No patient thus far has required revision surgery for any neurologic, wound, instrumentation, or fusion complication.

Conclusion: A posterior-based VCR is a safe but challenging technique to treat severe primary or revision spinal deformities with no spinal cord-related, wound, instrumentation, or fusion complications thus far. Intraoperative SCM (especially motor-evoked potentials) is mandatory to prevent spinal cord-related neurologic complications.
 

The Scoliosis Research Society provides information on these web pages regarding research and links as a public service. The SRS believes that patients should contact their treating physician about the relevance of any information listed on the site prior to proceeding with any particular treatment. Just as no two individuals are exactly alike, no two patients with a spinal deformity are the same. Therefore, your spinal deformity surgeon will be the most important source of information about the management of your particular spinal problem.