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Matched Cohort Analysis of Posterior-Only Vertebral Column Resection Versus Combined Anterior/Posterior Vertebrectomy for Severe Spinal Deformity

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Abstract

Study Design

Retrospective matched cohort analysis.

Summary of Background Data

Posterior-only vertebral column resection (P-VCR) is a potential alternative to combined anterior/ posterior vertebrectomy (A-P/VCR) for the treatment of severe spinal deformity.

Objective

To examine a matched cohort of adult and pediatric patients with severe spinal deformity treated with A/P-VCR versus P-VCR.

Methods

Databases of 2 spine surgeons at 1 institution from 1994 to 2007 were reviewed. Patients were matched based on age at surgery (within 10 years), diagnosis, curve pattern, vertebrae resected (within 1), levels of vertebrae resected (within 2), levels fused (within 5), and minimum 2-year follow-up. A total of 34 P-VCR patients were identified who appropriately matched 34 A/P-VCR patients. The etiology of the deformity and type of curve were matched directly so that they were identical for each matched pair. The remainder of the inclusion parameters was matched as closely as possible between the 2 groups according to the criteria listed above.

Results

Final coronal Cobb correction P-VCR versus A/P-VCR showed that 52.6% versus 53.9% (p =.8) was similar, whereas P-VCR final sagittal Cobb correction was superior: 53.0% versus 40.0% (p =.017). The P-VCR group had a significantly shorter total operative time (p =.002) and total length of stay (p =.003). Complications rates were similar and relatively infrequent for both P-VCR and A/P-VCR, including wound infections requiring operative intervention, subsequent revision surgery, and transient motor deficits. Total Scoliosis Research Society scores improved from preoperative to final follow-up for both P-VCR (p =.007) and A/P-VCR (p =.07) groups.

Conclusions

Posterior-only vertebral column resection is a challenging yet safe and effective means of treating severe scoliosis and/or kyphosis. Compared with an A/P-VCR for severe spinal deformity, P-VCR demonstrated shorter operative time and hospital stay, as well as improved sagittal correction and Scoliosis Research Society scores.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Shriners Hospital for Children, 3551 N Broad St Philadelphia, PA, Philadelphia, PA, 19140, USA

    Joshua M. Pahys MD

  2. Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S Euclid Avenue, Campus Box 8233, Saint Louis, MO, 63110-1010, USA

    Lawrence G. Lenke MD, Keith H. Bridwell MD, Lukas P. Zebala MD & Linda A. Koester BS

  3. Department of Orthopaedic Surgery, Mount Sinai School of Medicine, 1428 Madison Ave New York, NY, New York, NY, 10029, USA

    Samuel K. Cho MD

  4. Department of Neurosurgery, Regions Hospital, 640 Jackson St St. Paul, MN, Saint Paul, MN, 55101, USA

    Matthew M. Kang MD

  5. Department of Orthopaedic Surgery, Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461, USA

    Woojin Cho MD, PhD

Authors
  1. Joshua M. Pahys MD
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  2. Lawrence G. Lenke MD
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  3. Keith H. Bridwell MD
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  4. Samuel K. Cho MD
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  5. Lukas P. Zebala MD
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  6. Matthew M. Kang MD
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  7. Woojin Cho MD, PhD
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  8. Linda A. Koester BS
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Corresponding author

Correspondence to Lawrence G. Lenke MD.

Additional information

Author disclosures: JMP (consultancy for DePuy Spine); LGL Washington University, Department of Orthopaedic Surgery - Spine Service received grant monies from Axial Biotech, DePuy Synthes Spine, and AO-Spine & SRS (Scoli-RISK-1 study), philanthropic research funding from the Fox Family Foundation (Prospective Pediatric Spinal Deformity study), fellowship funding from AOSpine North America (funds/fellow year). Dr. Lenke shares numerous patents with Medtronic (unpaid). He is a consultant for DePuy Synthes Spine, K2M, Medtronic (monies donated to a charitable foundation). He receives substantial royalties from Medtronic and modest royalties from Quality Medical Publishing. Dr. Lenke also receives or has received reimbursement related to meetings/courses from AOSpine, BroadWater, DePuy Synthes Spine, K2M, Medtronic, Scoliosis Research Society, Seattle Science Foundation, Stryker Spine, The Spinal Research Foundation. KHB (multicenter grant from National Institutes of Health); SKC (none); LPZ (grants from AOSpine, DePuy; payment for lectures including service on speakers bureaus from DePuy); MMK (none); WC (none); LAK (none).

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Pahys, J.M., Lenke, L.G., Bridwell, K.H. et al. Matched Cohort Analysis of Posterior-Only Vertebral Column Resection Versus Combined Anterior/Posterior Vertebrectomy for Severe Spinal Deformity. Spine Deform 1, 439–446 (2013). https://doi.org/10.1016/j.jspd.2013.08.002

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  • DOI: https://doi.org/10.1016/j.jspd.2013.08.002

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