Abstract

ABDULLAH, S; ENRICO, N  and  DUNN, RN. Posterior vertebral column resection for severe spinal deformities. SA orthop. j. [online]. 2012, vol.11, n.4, pp.21-25. ISSN 2309-8309.

STUDY DESIGN: A retrospective review of patient records and imaging. OBJECTIVES: The purpose of this study is to review the indications, surgical challenges and outcomes of patients undergoing posterior vertebral column resection (PVCR). SUMMARY OF BACKGROUND DATA: PVCR is indicated in the management of severe rigid spine deformities. It is a complex surgical procedure and is only performed in a few spine centres due to the technical expertise required and associated risk. METHODS: Twelve patients with severe spinal deformities who underwent PVCR were retrospectively reviewed after a follow-up of 2 years. Surgery was performed with the aid of motor-evoked spinal cord monitoring and cell saver when available. The average surgical duration was 307 minutes (100-490 ± 126.3). The average blood loss was 1350 ml (4OO-3OOO ± 897.9). The indication for PVCR was gross deformity and myelopathy which was due to congenital spinal deformities and old tuberculosis (TB). Clinical records and the radiographic parameters were reviewed. RESULTS: Kyphosis of an average of 73° was corrected to 29° and coronal Cobb was corrected from an average of 48° to 22°. Ten patients improved neurologically to ASIA D and E. One patient deteriorated immediately post-operatively, required revision with no initial improvement but reached ASIA E by 6 months post-op. Four patients had associated syringomyelia. All were re-scanned at 1 year. The three with small syrinxes demonstrated no progression on MRI and a large syrinx resolved completely. In addition to the neurological deterioration, complications included one right lower-lobe pneumonia. CONCLUSION: PVCR is an effective option to correct complex rigid kyphoscoliosis. In addition it allows excellent circumferential decompression of the cord and neurological recovery. When the congenital scoliosis is associated with syringomyelia with no other cause evident, it may allow resolution of the syrinx.

Keywords : posterior vertebral column resection; severe spinal deformities; paraparesis.

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