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Posterior-Only Vertebral Column Resection for Fused Spondyloptosis

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Abstract

Study Design

Retrospective review.

Objectives

To describe 3 cases of a posterior-only vertebral column resection (pVCR) for the treatment of spondyloptosis in the setting of prior spinal fusions.

Summary of Background Data

Lumbosacral spondyloptosis is a rare spinal deformity with a number of surgical options, none of which demonstrate clear superiority. The use of an L5 vertebral column resection, via combined anterior and posterior approaches, to restore lumbosacral alignment has been described though is accompanied by high rates of neurological deficit.

Methods

Review of 3 cases of spondyloptosis with prior spinal fusions in which a staged pVCR was used for deformity reconstruction.

Results

Three females, ages 39, 54, and 28, developed spondyloptosis with progressive lumbosacral kyphosis and sagittal malalignment after prior in-situ posterolateral spinal fusions. All were treated with staged pVCRs. At ultimate follow-up, imaging revealed improvement in sagittal balance of 6.1 cm (56%) in the 39-year-old and 12 cm (67%) in the 54-year-old, 21.1 cm (92%) in the 28-year-old. All patients had improvement in outcome scores with perfect satisfaction scores despite the 54-year-old having a persistent right foot drop.

Conclusion

Posterior-only VCR for spondyloptosis is a technically demanding surgical option offering significant radiographic and clinical improvement, but carries a risk for L5 nerve root deficit as in any spondyloptosis treatment.

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Authors and Affiliations

  1. Norton Leatherman Spine Center, Louisville, KY, 40202, USA

    Jeffrey L. Gum MD

  2. Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, 63110, USA

    Jeffrey L. Gum MD & Michael P. Kelly MD

  3. The Spine Hospital, Department of Orthopedics, Columbia University Medical Center, New York City, NY, USA

    Lawrence G. Lenke MD & Sam Q. Sun MD

  4. Washington University School of Medicine, St. Louis, MO, 63110, USA

    Anand Mohapatra MD

Authors
  1. Jeffrey L. Gum MD
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  2. Lawrence G. Lenke MD
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  3. Anand Mohapatra MD
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  4. Sam Q. Sun MD
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  5. Michael P. Kelly MD
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Corresponding author

Correspondence to Lawrence G. Lenke MD.

Additional information

Author disclosures

JLG (consultancy fees from Medtronic, LifeSpine, Acuity, Corelink, Pacira Pharmaceuticals, PAKmed, Alphatec, Stryker, and Gerson Lehrman Group; employee of Norton Healthcare; payment for lectures including service on speakers bureaus from Medtronic and LifeSpine; travel paid to institution by Medtronic during fellowship 2013–2014; and travel paid to author during fellowship 2013–2014; fellowship support 2013–2014 from OREF and AO Spine; honorarium from Pacira, MiMedix, and Alphatec); LGL (board membership [unpaid positions] in Backtalk, Journal of Neurosurgery: Spine, Journal of Pediatric Orthopaedics, Journal of Spinal Disorders & Techniques, Scoliosis, Scoliosis Research Society, Spine Deformity, Spine, The Spine Journal, www.iscoliosis.com, and www.spineuniverse.com; consultancy fees [monies donated to a charitable foundation] from DePuy Synthes Spine, K2M, and Medtronic; grants to institution from AOSpine and Scoliosis Research Society, Axial Biotech, DePuy Synthes Spine; payment for lectures including service on speakers bureaus [monies donated to a charitable foundation] from DePuy Synthes Spine and K2M; unpaid patents from Medtronic; royalties from Medtronic, Quality Medical Publishing; travel expenses [reimbursement for airfare/hotel only] from AOSpine, BroadWater, DePuy Synthes Spine, K2M, Seattle Science Foundation, Scoliosis Research Society, Stryker Spine, The Spinal Research Foundation; fellowship grant [institutional support for fellowship] from AOSpine North America; philanthropic research funding from Fox Family Foundation); AM (none); SQS (none); MPK (consultancy fees from Advance Medical; grants to institution from OREF, Barnes-Jewish Hospital Foundation, and AOSpine).

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Gum, J.L., Lenke, L.G., Mohapatra, A. et al. Posterior-Only Vertebral Column Resection for Fused Spondyloptosis. Spine Deform 6, 84–95 (2018). https://doi.org/10.1016/j.jspd.2017.06.002

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  • DOI: https://doi.org/10.1016/j.jspd.2017.06.002

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