Posterior vertebral column resection for severe pediatric deformity: minimum two-year follow-up of thirty-five consecutive patients

Abstract

Study design: Retrospective review of a prospectively accrued patient cohort.

Objective: The ability to treat severe pediatric spinal deformity through an all-posterior vertebral column resection (VCR) has obviated the need for a circumferential approach in both primary and revision settings. We examined indications, correction rates, and complications of this challenging procedure in the pediatric population.

Summary of background data: Traditionally, severe pediatric spinal deformities were treated through a combined anterior/posterior spinal fusion.

Methods: Between 2000 and 2005, 35 consecutive patients underwent a posterior-only VCR by 1 of 2 surgeons at a single institution. Patients were divided into 5 diagnostic categories: (1) severe scoliosis (S) (n = 2; mean, 115 degrees; range, 79-150 degrees; average flexibility, 12%); (2) global kyphosis (GK) (n = 3; mean, 101 degrees; range, 91-113 degrees; average flexibility, 16%); (3) angular kyphosis (AK) (n = 10; mean, 86 degrees; range, 45-135 degrees, average flexibility, 23%); (4) kyphoscoliosis (KS) (n = 8; mean kyphosis, 103 degrees/scoliosis 87 degrees; mean combined, 190 degrees; range, 144-237 degrees); (5) congenital scoliosis (CS) (n = 12; mean, 43 degrees; range, 23-69 degrees; average flexibility, 20%). There were 20 primary/15 revision surgeries. There were 20 one-level, 11 two-level, and 4 three-level resections.

Results: The major curve correction averaged: Group S = 61 degrees/51%, Group GK = 56 degrees/55%, Group AK = 51 degrees/58%, Group KS = 98 degrees/54%, and Group CS = 24 degrees/60%. The average OR time was 460 minutes (range, 210-822), with an average EBL of 691 mL (range, 125-2200). There were no spinal cord-related complications; however, 2 patients (8.5%) lost intraoperative neuromonitoring data during correction with data returning to baseline following prompt surgical intervention. Two patients had implant revisions, 1 for a delayed deep infection at 2 years and the other for implant prominence at 3-year follow-up.

Conclusion: A posterior-based VCR is a safe but challenging technique to treat severe primary or revision pediatric spinal deformities. Intraoperative SCM (especially motor-evoked potentials) is mandatory to prevent spinal cord-related neurologic complications. Dramatic radiographic and clinical correction of these deformities can be obtained via a posterior-only approach.