Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Clinical and Radiological Outcomes of Posterior Vertebral Column Resection for Severe Spinal Deformities

  • Lee, Byoung Hun (Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Hyun, Seung-Jae (Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Kim, Ki-Jeong (Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Jahng, Tae-Ahn (Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Kim, Yongjung J. (Department of Orthopaedic Surgery, Spine Service, Columbia University College of Physicians and Surgeons) ;
  • Kim, Hyun-Jib (Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine)
  • Received : 2017.06.04
  • Accepted : 2017.08.30
  • Published : 2018.03.01
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Abstract

Objective : The aim of this study was to investigate clinical and radiological outcomes of patients who underwent posterior vertebral column resection (PVCR) by a single neurosurgeon in a single institution. Methods : Thirty-four consecutive patients with severe spinal deformities who underwent PVCR between 2010 and 2016 were enrolled. The radiographic measurements included a kyphotic angle of PVCR levels (VCR angle), sagittal vertical axis (SVA), thoracic kyphosis, lumbar lordosis (LL), and spinopelvic parameters. The data of surgical time, estimated blood loss, duration of hospital stay, complications, intraoperative neurophysiologic monitoring, and the Scoliosis Research Society (SRS)-22 questionnaire were collected using a retrospective review of medical records. Results : The VCR angle, LL, and SVA values were significantly corrected after surgery. The VCR and LL angle were changed from the average of $38.4{\pm}32.1^{\circ}$ and $-22.1{\pm}39.1^{\circ}$ to $-1.7{\pm}29.4^{\circ}$ (p<0.001) and $-46.3{\pm}23.8^{\circ}$ (p=0.001), respectively. The SVA was significantly reduced from $103.6{\pm}88.5mm$ to $22.0{\pm}46.3mm$ (p=0.001). The clinical results using SRS-22 survey improved from $2.6{\pm}0.9$ to $3.4{\pm}0.8$ (p=0.033). There were no death and permanent neurological deficits after PVCR. However, complications occurred in 19 (55.9%) patients. Those patients experienced a total of 31 complications during- and after surgery. Sixteen reoperations were performed in twelve (35.3%) patients. The incidence of transient neurological deterioration was 5.9% (two out of 34 patients). Conclusion : Severe spinal deformities can be effectively corrected by PVCR. However, the PVCR technique should be utilized limitedly because surgery-related serious complications are relatively common.

Keywords

References

  1. Auerbach JD, Lenke LG, Bridwell KH, Sehn JK, Milby AH, Bumpass D, et al. : Major complications and comparison between 3-column osteotomy techniques in 105 consecutive spinal deformity procedures. Spine (Phila Pa 1976) 37 : 1198-1210, 2012 https://doi.org/10.1097/BRS.0b013e31824fffde
  2. Boachie-Adjei O, Bradford DS : Vertebral column resection and arthrodesis for complex spinal deformities. J Spinal Disord 4 : 193-202, 1991 https://doi.org/10.1097/00002517-199106000-00010
  3. Bradford DS, Tribus CB : Vertebral column resection for the treatment of rigid coronal decompensation. Spine (Phila Pa 1976) 22 : 1590-1599, 1997 https://doi.org/10.1097/00007632-199707150-00013
  4. Choi HY, Hyun SJ, Kim KJ, Jahng TA, Kim HJ : Effectiveness and safety of tranexamic acid in spinal deformity surgery. J Korean Neurosurg Soc 60 : 75-81, 2017 https://doi.org/10.3340/jkns.2016.0505.004
  5. Demirkiran G, Dede O, Karadeniz E, Olgun D, Ayvaz M, Yazici M : Anterior and posterior vertebral column resection versus posterior-only technique: a comparison of clinical outcomes and complications in congenital kyphoscoliosis. Clin Spine Surg 30 : 285-290, 2016
  6. Enercan M, Ozturk C, Kahraman S, Sarier M, Hamzaoglu A, Alanay A : Osteotomies/spinal column resections in adult deformity. Eur Spine J 22 Suppl 2 : S254-S264, 2013 https://doi.org/10.1007/s00586-012-2313-0
  7. Hamzaoglu A, Alanay A, Ozturk C, Sarier M, Karadereler S, Ganiyusufoglu K : Posterior vertebral column resection in severe spinal deformities: a total of 102 cases. Spine (Phila Pa 1976) 36 : E340-E344, 2011 https://doi.org/10.1097/BRS.0b013e3182015712
  8. Hyun SJ, Lenke LG, Kim YC, Koester LA, Blanke KM : Comparison of standard 2-rod constructs to multiple-rod constructs for fixation across 3-column spinal osteotomies. Spine (Phila Pa 1976) 39 : 1899-1904, 2014 https://doi.org/10.1097/BRS.0000000000000556
  9. Hyun SJ, Rhim SC : Clinical outcomes and complications after pedicle subtraction osteotomy for fixed sagittal imbalance patients: a long-term follow-up data. J Korean Neurosurg Soc 47 : 95-101, 2010 https://doi.org/10.3340/jkns.2010.47.2.95
  10. Kawahara N, Tomita K, Baba H, Kobayashi T, Fujita T, Murakami H : Closing-opening wedge osteotomy to correct angular kyphotic deformity by a single posterior approach. Spine (Phila Pa 1976) 26 : 391-402, 2001 https://doi.org/10.1097/00007632-200102150-00016
  11. Lenke LG, Newton PO, Sucato DJ, Shufflebarger HL, Emans JB, Sponseller PD, et al. : Complications after 147 consecutive vertebral column resections for severe pediatric spinal deformity: a multicenter analysis. Spine (Phila Pa 1976) 38 : 119-132, 2013 https://doi.org/10.1097/BRS.0b013e318269fab1
  12. Lenke LG, O'Leary PT, Bridwell KH, Sides BA, Koester LA, Blanke KM : Posterior vertebral column resection for severe pediatric deformity: minimum two-year follow-up of thirty-five consecutive patients. Spine (Phila Pa 1976) 34 : 2213-2221, 2009 https://doi.org/10.1097/BRS.0b013e3181b53cba
  13. Lenke LG, Sides BA, Koester LA, Hensley M, Blanke KM : Vertebral column resection for the treatment of severe spinal deformity. Clin Orthop Relat Res 468 : 687-699, 2010 https://doi.org/10.1007/s11999-009-1037-x
  14. Liu C, Lin L, Wang W, Lv G, Deng Y : Long-term outcomes of vertebral column resection for kyphosis in patients with cured spinal tuberculosis: average 8-year follow-up. J Neurosurg Spine 24 : 777-785, 2016 https://doi.org/10.3171/2015.8.SPINE15534
  15. Smith JS, Wang VY, Ames CP : Vertebral column resection for rigid spinal deformity. Neurosurgery 63(3 Suppl) : A177-A182, 2008 https://doi.org/10.1227/01.NEU.0000320429.32113.85
  16. Suk SI, Chung ER, Kim JH, Kim SS, Lee JS, Choi WK : Posterior vertebral column resection for severe rigid scoliosis. Spine (Phila Pa 1976) 30 : 1682-1687, 2005 https://doi.org/10.1097/01.brs.0000170590.21071.c1
  17. Suk SI, Kim JH, Kim WJ, Lee SM, Chung ER, Nah KH : Posterior vertebral column resection for severe spinal deformities. Spine (Phila Pa 1976) 27 : 2374-2382, 2002 https://doi.org/10.1097/00007632-200211010-00012
  18. Tao Y, Wu J, Ma H, Zhang L, Shao S, Si Z, et al. : Posterior vertebral column resection for severe and rigid spinal deformity associated with neurological deficit after implant removal following posterior instrumented fusion: a case report and literature review. Spine (Phila Pa 1976) 40 : E794-E798, 2015 https://doi.org/10.1097/BRS.0000000000000921
  19. Terran J, Schwab F, Shaffrey CI, Smith JS, Devos P, Ames CP, et al. : The SRS-Schwab adult spinal deformity classification: assessment and clinical correlations based on a prospective operative and nonoperative cohort. Neurosurgery 73 : 559-568, 2013 https://doi.org/10.1227/NEU.0000000000000012
  20. Xie JM, Zhang Y, Wang YS, Bi N, Zhao Z, Li T, et al. : The risk factors of neurologic deficits of one-stage posterior vertebral column resection for patients with severe and rigid spinal deformities. Eur Spine J 23 : 149-156, 2014 https://doi.org/10.1007/s00586-013-2793-6
  21. Yang C, Zheng Z, Liu H, Wang J, Kim YJ, Cho S : Posterior vertebral column resection in spinal deformity: a systematic review. Eur Spine J 25 : 2368-2375, 2016 https://doi.org/10.1007/s00586-015-3767-7
  22. Zhang BB, Zhang T, Tao HR, Wu TL, Duan CG, Yang WZ, et al. : Neurological complications of thoracic posterior vertebral column resection for severe congenital spinal deformities. Eur Spine J 26 : 1871-1877, 2017 https://doi.org/10.1007/s00586-017-5061-3

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