Posterior Vertebral Column Resection for Severe Pediatric Deformity

In Brief 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°; range, 79–150°; average flexibility, 12%); (2) global kyphosis (GK) (n = 3; mean, 101°; range, 91–113°; average flexibility, 16%); (3) angular kyphosis (AK) (n = 10; mean, 86°; range, 45–135°, average flexibility, 23%); (4) kyphoscoliosis (KS) (n = 8; mean kyphosis, 103°/scoliosis 87°; mean combined, 190°; range, 144–237°); (5) congenital scoliosis (CS) (n = 12; mean, 43°; range, 23–69°; 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°/51%, Group GK = 56°/55%, Group AK = 51°/58%, Group KS = 98°/54%, and Group CS = 24°/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. The ability to treat severe pediatric spinal deformity through an all-posterior vertebral column resection approach has obviated the need for a circumferential approach. Intraoperative use of spinal cord monitoring is mandatory to prevent neurologic complications. Although technically challenging, a single stage approach offers dramatic correction in both primary and revision surgery.