Clinical Orthopaedics and Related Research®

, Volume 468, Issue 3, pp 687–699 | Cite as

Vertebral Column Resection for the Treatment of Severe Spinal Deformity

  • Lawrence G. Lenke
  • Brenda A. Sides
  • Linda A. Koester
  • Marsha Hensley
  • Kathy M. Blanke
Symposium: Pediatric Spine

Abstract

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.

Level of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Notes

Acknowledgments

We thank the many spine fellows at Washington University St Louis who assisted in these complex surgeries and managing the patients postoperatively.

Supplementary material

11999_2009_1037_MOESM1_ESM.doc (28 kb)
Supplementary material 1 (DOC 29 kb)

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Copyright information

© The Association of Bone and Joint Surgeons® 2009

Authors and Affiliations

  • Lawrence G. Lenke
    • 1
  • Brenda A. Sides
    • 1
  • Linda A. Koester
    • 1
  • Marsha Hensley
    • 2
  • Kathy M. Blanke
    • 1
  1. 1.Department of Orthopaedic SurgeryWashington University School of MedicineSt LouisUSA
  2. 2.Shriners Hospital for ChildrenSt LouisUSA

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