Advertisement

European Spine Journal

, Volume 25, Issue 8, pp 2368–2375 | Cite as

Posterior vertebral column resection in spinal deformity: a systematic review

  • Changsheng Yang
  • Zhaomin ZhengEmail author
  • Hui Liu
  • Jianru Wang
  • Yongjung Jay Kim
  • Samuel Cho
Review Article

Abstract

Purpose

This study aimed to assess the amount of correction and risk of complications of posterior vertebral column resection (PVCR) in the treatment of spinal deformity.

Methods

A comprehensive research was conducted in MEDLINE, EMBASE and Cochrane Database of Systematic Reviews for published articles about PVCR in spinal deformity. Data from these included studies were pooled with the help of the Review Manager software from the Cochrane Collaboration and the R software. The amount of correction of PVCR was indicated with change of coronal and sagittal Cobb angle after operation. Risk of complications was demonstrated with prevalence.

Results

7 studies, a total of 390 patients, were included for analysis. The average operative time for PVCR was 430 min and the estimated blood loss was 2,639 ml. The mean amount of correction by PVCR was 64.1° in scoliosis and 58.9° in kyphosis, accounting a correction rate of 61.2 and 63.1 %, respectively. As to coronal and sagittal imbalance, data were limited. The overall prevalence of complications of PVCR was 32 % (95 % CI 12–54 %). The most common was neurologic complications, estimated to be 8 % (95 % CI 2–16 %). And risk of spinal cord injury was 2 % (95 % CI 0–3 %). The revision rate was 6 % (95 % CI 1–13 %). Incidence of infection was pooled to be 2 % (95 % CI 1–4 %). Complication rate related with implant was 2 % (95 % CI 0–6 %).

Conclusion

PVCR is a powerful surgical procedure for severe spinal deformity. However, it has the risk of excessive blood loss and major complications. Decision of PVCR should be prudent and the procedure should be performed by an experienced surgical team.

Keywords

Posterior vertebral column resection Spinal deformity Scoliosis Kyphosis Complication 

Notes

Acknowledgments

No funds were received in support of this work.

Conflict of interest

No conflict of interest.

References

  1. 1.
    Lenke LG, Newton PO, Sucato DJ et al (2013) Complications after 147 consecutive vertebral column resections for severe pediatric spinal deformity: a multicenter analysis. Spine (Phila Pa 1976) 38(2):119–132CrossRefGoogle Scholar
  2. 2.
    MacLennan A (1922) Scoliosis. Spine (Phila Pa 1976) 2:864–866Google Scholar
  3. 3.
    Luque ER (1983) Vertebral column transposition. Orthopaedic transaction. J Bone Joint Surg Am 7:29–32Google Scholar
  4. 4.
    Bradford DS (1987) Vertebral column resection. Orthop Trans 11:502–505Google Scholar
  5. 5.
    Bradford DS, Tribus CB (1997) Vertebral column resection for the treatment of rigid coronal decompensation. Spine (Phila Pa 1976) 22(14):1590–1599CrossRefGoogle Scholar
  6. 6.
    Boachie-Adjei O, Bradford DS (1991) Vertebral column resection and arthrodesis for complex spinal deformities. J Spinal Disord 4(2):193–202CrossRefPubMedGoogle Scholar
  7. 7.
    Suk SI, Kim JH, Kim WJ, Lee SM, Chung ER, Nah KH (2002) Posterior vertebral column resection for severe spinal deformities. Spine (Phila Pa 1976) 27(21):2374–2382CrossRefGoogle Scholar
  8. 8.
    Magerl F, Coscia MF (1988) Total posterior vertebrectomy of the thoracic or lumbar spine. Clin Orthop Relat Res 232:62–69PubMedGoogle Scholar
  9. 9.
    Hamzaoglu A, Alanay A, Ozturk C, Sarier M, Karadereler S, Ganiyusufoglu K (2011) Posterior vertebral column resection in severe spinal deformities: a total of 102 cases. Spine (Phila Pa 1976) 36(5):E340–E344CrossRefGoogle Scholar
  10. 10.
    Suk SI, Chung ER, Kim JH, Kim SS, Lee JS, Choi WK (2005) Posterior vertebral column resection for severe rigid scoliosis. Spine (Phila Pa 1976) 30(14):1682–1687CrossRefGoogle Scholar
  11. 11.
    Suk SI, Chung ER, Lee SM, Lee JH, Kim SS, Kim JH (2005) Posterior vertebral column resection in fixed lumbosacral deformity. Spine (Phila Pa 1976) 30(23):E703–E710CrossRefGoogle Scholar
  12. 12.
    Higgins JPT, Green S (2011) Cochrane handbook for systematic reviews of interventions Version 5.1.0. Part 2, 7.7.3 and Part 3, 16.1.3. The Cochrane Collaboration. 2011Google Scholar
  13. 13.
    Bumpass DB, Lenke LG, Bridwell KH et al (2014) Pulmonary function improvement after vertebral column resection for severe spinal deformity. Spine (Phila Pa 1976) 39(7):587–595CrossRefGoogle Scholar
  14. 14.
    Kim SS, Cho BC, Kim JH et al (2012) Complications of posterior vertebral resection for spinal deformity. Asian Spine J 6(4):257–265CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Lenke LG, O’Leary PT, Bridwell KH, Sides BA, Koester LA, Blanke KM (2009) Posterior vertebral column resection for severe pediatric deformity: minimum two-year follow-up of thirty-five consecutive patients. Spine (Phila Pa 1976) 34(20):2213–2221CrossRefGoogle Scholar
  16. 16.
    Lenke LG, Sides BA, Koester LA, Hensley M, Blanke KM (2010) Vertebral column resection for the treatment of severe spinal deformity. Clin Orthop Relat Res 468(3):687–699CrossRefPubMedGoogle Scholar
  17. 17.
    Ozturk C, Alanay A, Ganiyusufoglu K, Karadereler S, Ulusoy L, Hamzaoglu A (2012) Short-term X-ray results of posterior vertebral column resection in severe congenital kyphosis, scoliosis, and kyphoscoliosis. Spine (Phila Pa 1976) 37(12):1054–1057CrossRefGoogle Scholar
  18. 18.
    Xie J, Li T, Wang Y, Zhao Z, Zhang Y, Bi N (2012) Change in Cobb angle of each segment of the major curve after posterior vertebral column resection (PVCR): a preliminary discussion of correction mechanisms of PVCR. Eur Spine J 21(4):705–710CrossRefPubMedGoogle Scholar
  19. 19.
    Xie J, Wang Y, Zhao Z et al (2012) Posterior vertebral column resection for correction of rigid spinal deformity curves greater than 100 degrees. J Neurosurg Spine 17(6):540–551CrossRefPubMedGoogle Scholar
  20. 20.
    Xie JM, Zhang Y, Wang YS et al (2014) 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(1):149–156CrossRefPubMedGoogle Scholar
  21. 21.
    Zeng Y, Chen Z, Guo Z, Qi Q, Li W, Sun C (2013) Complications of correction for focal kyphosis after posterior osteotomy and the corresponding management. J Spinal Disord Tech 26(7):367–374CrossRefPubMedGoogle Scholar
  22. 22.
    Zeng Y, Chen Z, Qi Q et al (2013) The posterior surgical correction of congenital kyphosis and kyphoscoliosis: 23 cases with minimum 2 years follow-up. Eur Spine J 22(2):372–378CrossRefPubMedGoogle Scholar
  23. 23.
    Zeng Y, Chen Z, Qi Q et al (2012) Clinical and radiographic evaluation of posterior surgical correction for the treatment of moderate to severe post-tuberculosis kyphosis in 36 cases with a minimum 2-year follow-up. J Neurosurg Spine 16(4):351–358CrossRefPubMedGoogle Scholar
  24. 24.
    Zhang HQ, Li JS, Liu SH et al (2013) The use of posterior vertebral column resection in the management of severe posttuberculous kyphosis: a retrospective study and literature review. Arch Orthop Trauma Surg 133(9):1211–1218CrossRefPubMedGoogle Scholar
  25. 25.
    Papadopoulos EC, Boachie-Adjei O, Hess WF et al Early outcomes and complications of posterior vertebral column resection. Spine J. In press. Epub ahead of print: April 29, 2013Google Scholar
  26. 26.
    Schwab F, Ungar B, Blondel B et al (2012) Scoliosis Research Society-Schwab adult spinal deformity classification: a validation study. Spine (Phila Pa 1976) 37(12):1077–1082CrossRefGoogle Scholar
  27. 27.
    Sucato DJ (2010) Management of severe spinal deformity: scoliosis and kyphosis. Spine (Phila Pa 1976) 35(25):2186–2192CrossRefGoogle Scholar
  28. 28.
    Kim KT, Lee SH, Suk KS, Lee JH, Jeong BO (2012) Outcome of pedicle subtraction osteotomies for fixed sagittal imbalance of multiple etiologies: a retrospective review of 140 patients. Spine (Phila Pa 1976) 37(19):1667–1675CrossRefGoogle Scholar
  29. 29.
    Coe JD, Arlet V, Donaldson W et al (2006) Complications in spinal fusion for adolescent idiopathic scoliosis in the new millennium. A report of the Scoliosis Research Society Morbidity and Mortality Committee. Spine (Phila Pa 1976) 31(3):345–349CrossRefGoogle Scholar
  30. 30.
    Buchowski JM, Bridwell KH, Lenke LG et al (2007) Neurologic complications of lumbar pedicle subtraction osteotomy: a 10-year assessment. Spine (Phila Pa 1976) 32(20):2245–2252CrossRefGoogle Scholar
  31. 31.
    Kelly MP, Lenke LG, Shaffrey CI et al (2014) Evaluation of complications and neurological deficits with three-column spine reconstructions for complex spinal deformity: a retrospective Scoli-RISK-1 study. Neurosurg Focus 36(5):E17CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Ren C, Liu L, Song Y, Zhou C, Liu H, Li T (2014) Comparison of anterior and posterior vertebral column resection versus anterior release with posterior internal distraction for severe and rigid scoliosis. Eur Spine J 23(6):1237–1243 Epub 2014 MarCrossRefPubMedGoogle Scholar
  33. 33.
    Newton PO, Perry A, Bastrom TP et al (2007) Predictors of change in postoperative pulmonary function in adolescent idiopathic scoliosis: a prospective study of 254 patients. Spine (Phila Pa 1976) 32(17):1875–1882CrossRefGoogle Scholar
  34. 34.
    Graham EJ, Lenke LG, Lowe TG et al (2000) Prospective pulmonary function evaluation following open thoracotomy for anterior spinal fusion in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 25(18):2319–2325CrossRefGoogle Scholar
  35. 35.
    Kim YJ, Lenke LG, Bridwell KH, Kim KL, Steger-May K (2005) Pulmonary function in adolescent idiopathic scoliosis relative to the surgical procedure. J Bone Joint Surg Am 87(7):1534–1541CrossRefPubMedGoogle Scholar
  36. 36.
    Gitelman Y, Lenke LG, Bridwell KH, Auerbach JD, Sides BA (2011) Pulmonary function in adolescent idiopathic scoliosis relative to the surgical procedure: a 10-year follow-up analysis. Spine (Phila Pa 1976) 36(20):1665–1672CrossRefGoogle Scholar
  37. 37.
    Lonner BS, Auerbach JD, Estreicher MB et al (2009) Pulmonary function changes after various anterior approaches in the treatment of adolescent idiopathic scoliosis. J Spinal Disord Tech 22(8):551–558CrossRefPubMedGoogle Scholar
  38. 38.
    Lenke LG, Bridwell KH, Blanke K, Baldus C (1995) Analysis of pulmonary function and chest cage dimension changes after thoracoplasty in idiopathic scoliosis. Spine (Phila Pa 1976) 20(12):1343–1350CrossRefGoogle Scholar
  39. 39.
    Sponseller PD, Takenaga RK, Newton P et al (2008) The use of traction in the treatment of severe spinal deformity. Spine (Phila Pa 1976) 33(21):2305–2309CrossRefGoogle Scholar
  40. 40.
    Koptan W, ElMiligui Y (2012) Three-staged correction of severe rigid idiopathic scoliosis using limited halo-gravity traction. Eur Spine J 21(6):1091–1098CrossRefPubMedGoogle Scholar
  41. 41.
    Park DK, Braaksma B, Hammerberg KW, Sturm P (2013) The efficacy of preoperative halo-gravity traction in pediatric spinal deformity the effect of traction duration. J Spinal Disord Tech 26(3):146–154CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Changsheng Yang
    • 1
  • Zhaomin Zheng
    • 1
    Email author
  • Hui Liu
    • 1
  • Jianru Wang
    • 1
  • Yongjung Jay Kim
    • 2
  • Samuel Cho
    • 3
  1. 1.Department of Spine Surgery, The First Affiliated HospitalSun Yat-sen UniversityGuangzhouChina
  2. 2.Department of Orthopaedic SurgeryColumbia University, College of Physicians and SurgeonsNew YorkUSA
  3. 3.Department of Orthopaedic SurgeryIcahn School of Medicine at Mount SinaiNew YorkUSA

Personalised recommendations