Vertebral column resection for the treatment of severe spinal deformity.
The ability to treat severe pediatric and adult spinal deformities through an all-posterior vertebral column resection (VCR) has obviated the need for a circumferential approach in primary and revision surgery, but there is limited literature evaluating this new approach. Our purpose was therefore to provide further support of this technique. We reviewed 43 patients who underwent a posterior-only VCR using pedicle screws, anteriorly positioned cages, and intraoperative spinal cord monitoring between 2002 and 2006. Diagnoses included severe scoliosis, global kyphosis, angular kyphosis, or kyphoscoliosis. Forty (93%) procedures were performed at L1 or cephalad in the spinal cord (SC) territory. Seven patients (18%) lost intraoperative neurogenic monitoring evoked potentials (NMEPs) data during correction with data returning to baseline after prompt surgical intervention. All patients after surgery were at their baseline or showed improved SC function, whereas no one worsened. Two patients had nerve root palsies postoperatively, which resolved spontaneously at 6 months and 2 weeks. Spinal cord monitoring (specifically NMEP) is mandatory to prevent neurologic complications. Although technically challenging, a single-stage approach offers dramatic correction in both primary and revision surgery of severe spinal deformities.


METHODS
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Lenke
Lawrence G
LG
Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S Euclid Avenue, Campus Box 8233, St Louis, MO 63110, USA. lenkel@wudosis.wustl.edu
Sides
Brenda A
BA
Koester
Linda A
LA
Hensley
Marsha
M
Blanke
Kathy M
KM
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D004558:Electric Stimulation; D019054:Evoked Potentials, Motor; D005073:Evoked Potentials, Somatosensory; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods*; D011859:Radiography; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D013121:Spinal Curvatures / Q000151:congenital* / Q000000981:diagnostic imaging / Q000601:surgery*; D013131:Spine / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult