scholarly journals Congenital scoliosis treated with posterior vertebral column resection in patients younger than 18 years: longer than 10-year follow-up

2016 ◽  
Vol 25 (2) ◽  
pp. 225-233 ◽  
Author(s):  
Dong-Gune Chang ◽  
Jae Hyuk Yang ◽  
Jung-Hee Lee ◽  
Jin-Hyok Kim ◽  
Seung-Woo Suh ◽  
...  
Keyword(s):  
Cobb Angle ◽  
Vertebral Column ◽  
Congenital Scoliosis ◽  
Rigid Fixation ◽  
Vertebral Column Resection ◽  
Posterior Vertebral Column Resection ◽  
Time Of Surgery ◽  
The Mean

OBJECTIVE There have been no reports on the long-term radiographic outcomes of posterior vertebral column resection (PVCR) in patients with congenital scoliosis. The purpose of this study was to evaluate the surgical outcomes and complications after PVCR and its long-term effects on correcting this deformity in children with congenital scoliosis. METHODS The authors retrospectively analyzed the medical records of 45 patients with congenital scoliosis who were younger than 18 years at the time of surgery and who underwent PVCR and fusion with pedicle screw fixation (PSF). The mean age of the patients at the time of surgery was 11.3 years (range 2.4–18.0 years), and the mean length of follow-up was 12.8 years (range 10.1–18.2 years). RESULTS The mean Cobb angle of the main curve was 46.5° before PVCR, 13.7° immediately after PVCR, and 17.6° at the last follow-up. For the compensatory cranial curve, PVCR corrected the preoperative Cobb angle of 21.2° to 9.1° postoperatively and maintained it at 10.9° at the last follow-up. For the compensatory caudal curve, the preoperative Cobb angle of 23.8° improved to 7.7° postoperatively and was 9.8° at the last follow-up. The authors noted 22 complications, and the overall incidence of complications was 48.9%. CONCLUSIONS Posterior vertebral column resection is an effective procedure for managing congenital scoliosis in patients younger than 18 years. Use of PVCR and fusion with PSF for congenital scoliosis achieved rigid fixation and satisfactory deformity correction that was maintained over the long term. However, the authors note that PVCR is a technically demanding procedure and entails risks for major complications and excessive blood loss.

scholarly journals Single-Stage Posterior Vertebral Column Resection With Circumferential Reconstruction for Thoracic/Thoracolumbar Burst Fractures With or Without Neurological Deficit: Clinical Neurological and Radiological Outcomes

2020 ◽  
pp. 219256822096445
Author(s):  
Azmi Hamzaoglu ◽  
Mustafa Elsadig ◽  
Selhan Karadereler ◽  
Ayhan Mutlu ◽  
Yunus Emre Akman ◽  
...  
Keyword(s):  
Neurological Deficit ◽  
Vertebral Column ◽  
Single Stage ◽  
Anterior Column ◽  
Vertebral Column Resection ◽  
Posterior Vertebral Column Resection ◽  
Thoracolumbar Burst Fractures ◽  
Burst Fractures ◽  
The Mean

Study Design: Retrospective study. Objective: The aim of this study is to evaluate the clinical, neurological, and radiological outcomes of posterior vertebral column resection (PVCR) technique for treatment of thoracic and thoracolumbar burst fractures. Methods: Fifty-one patients (18 male, 33 female) with thoracic/thoracolumbar burst fractures who had been treated with PVCR technique were retrospectively reviewed. Preoperative and most recent radiographs were evaluated and local kyphosis angle (LKA), sagittal and coronal spinal parameters were measured. Neurological and functional results were assessed by the American Spinal Injury Association (ASIA) Impairment Scale, visual analogue scale score, Oswestry Disability Index, and Short Form 36 version 2. Results: The mean age was 49 years (range 22-83 years). The mean follow-up period was 69 months (range 28-216 months). Fractures were thoracic in 16 and thoracolumbar in 35 of the patients. AO spine thoracolumbar injury morphological types were as follows: 1 type A3, 15 type A4, 4 type B1, 23 type B2, 8 type C injuries. PVCR was performed in a single level in 48 of the patients and in 2 levels in 3 patients. The mean operative time was 434 minutes (range 270-530 minutes) and mean intraoperative blood loss was 520 mL (range 360-1100 mL). The mean LKA improved from 34.7° to 4.9° (85.9%). For 27 patients, the initial neurological deficit (ASIA A in 8, ASIA B in 3, ASIA C in 5, and ASIA D in 11) improved at least 1 ASIA grade (1-3 grades) in 22 patients (81.5%). Solid fusion, assessed with computed tomography at the final follow-up, was achieved in all patients. Conclusion: Single-stage PVCR provides complete spinal canal decompression, ideal kyphosis correction with gradual lengthening of anterior column together with sequential posterior column compression. Anterior column support, avoidance of the morbidity of anterior approach and improvement of neurological deficit are the other advantages of the single stage PVCR technique in patients with thoracic/thoracolumbar burst fractures.

Posterior vertebral column resection for correction of rigid spinal deformity curves greater than 100°

2012 ◽  
Vol 17 (6) ◽  
pp. 540-551 ◽  
Author(s):  
Jingming Xie ◽  
Yingsong Wang ◽  
Zhi Zhao ◽  
Ying Zhang ◽  
Yongyu Si ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Vertebral Column ◽  
Sagittal Plane ◽  
Coronal Plane ◽  
Plane Curves ◽  
Vertebral Column Resection ◽  
Posterior Vertebral Column Resection ◽  
Correction Rate ◽  
The Mean

Object The surgical treatment of severe and rigid spinal deformities poses difficulties and dangers. In this article, the authors summarize their surgical techniques and evaluate patient outcomes after performing posterior vertebral column resection (PVCR) for the correction of spinal deformities with curves greater than 100°, and investigate the crucial points to ensure neurological safety during this challenging procedure. Methods The authors retrospectively reviewed their experience with 28 patients with extremely severe (Cobb angles in the coronal or sagittal plane > 100°) and rigid thoracic or thoracolumbar spine deformities who underwent PVCR. The average patient age was 20.2 years and all patients underwent a minimum follow-up of 24 months (range 24–60 months). Patients were divided into groups according to their morphological classification as follows: kyphosis alone (Group A, 6 patients with a mean Cobb angle of 109.0° [range 105°–120°]); kyphoscoliosis with coronal plane curves notably greater than sagittal plane curves (Group B, 14 patients with mean scoliotic curves of 116.6° [range 102°–170°] and kyphotic curves of 77.7° [range 42°–160°]); and kyphoscoliosis with sagittal curves notably greater than coronal plane curves (Group C, 8 patients with a mean coronal curve of 85.4° [range 65°–110°] and a mean sagittal curve of 117.6° [range 102°–155°]). Results A total of 36 vertebrae were removed in 28 patients who had a severe rigid spinal deformity, and the mean fusion extent was 13.3 vertebrae (range 7–17 vertebrae). The mean operating time was 620 minutes (range 320–920 minutes) with an average operative blood loss of 6,680 ml (range 3,000–24,000 ml). The overall final correction rate of scoliosis was 59.0%, and average postoperative kyphotic Cobb angles ranged from 30.4° to 95.9°. In Group A the mean preoperative sagittal angle of 109.0° was corrected to a mean postoperative angle of 32.0°. In the Group B kyphoscoliotic patients, the correction rate in the coronal plane was 58.6%; the Cobb angle in the sagittal plane was corrected from a mean of 77.7° preoperatively to 25.1° postoperatively; in Group C, the correction rate in the coronal plane was 58.5%, and the mean sagittal angle was reduced from a mean of 117.6° preoperatively to 39.0°. Of the 28 patients who underwent PVCR, 46 complications were observed in 18 patients intra- and postoperatively. There were 5 neurological complications including 1 case of late-onset paralysis and 4 cases of thoracic nerve root pain, all of which resolved during the early follow-up period. Nonneurological complications occurred more often in kyphoscoliotic patients (41 complications). The mean follow-up of all patients was 33.7 months (range 24–60 months). Conclusions Posterior vertebral column resection was effective in correcting severe rigid spinal deformity, although the procedure was technically demanding, exhaustingly lengthy, and was associated with a variety of complications. The PVCR technique created a space for spinal correction and spinal cord tension adjustment and the correction could be performed under direct inspection and by palpation of the tension in the spinal cord through the space. Therefore, in terms of the spinal cord, the deformity correction process involved in the PVCR procedure is relatively safe.

scholarly journals POSTERIOR VERTEBRAL COLUMN RESECTION IN MULTIPLE LEVELS IN CHILDREN WITH VERTEBRAL TUBERCULOSIS

2019 ◽  
Vol 18 (3) ◽  
pp. 217-221
Author(s):  
ALDERICO GIRÃO CAMPOS DE BARROS ◽  
LUIS EDUARDO CARELLI TEIXEIRA DA SILVA ◽  
MARCELO GLAUBER DA SILVA PEREIRA ◽  
ANDRE LUIZ LOYELO BARCELLOS ◽  
LUCAS ROCHA CAVALCANTI
Keyword(s):  
Neurological Deficit ◽  
Vertebral Column ◽  
Spinal Tuberculosis ◽  
Vertebral Column Resection ◽  
Posterior Vertebral Column Resection ◽  
Cord Injury ◽  
The Mean ◽  
Multiple Levels ◽  
Tuberculosis In Children

ABSTRACT Objective To evaluate the clinical and radiological results of posterior vertebral column resection in the treatment of kyphosis due to vertebral tuberculosis in children under 9 years of age with neurological deficit. Methods Retrospective study of a series of 5 cases, 4 females and 1 male, mean age of 4.7 years at the time of surgery, with spinal tuberculosis and mean kyphosis of 89 degrees. Results All patients underwent surgical treatment with PVCR in multiple levels, with a mean number of 3.6 resected vertebrae, mean surgical time of 359 minutes, mean postoperative stay of 21.2 days. The mean follow-up was 29 months. The mean kyphosis correction was 62.6%. Before surgery, all patients had signs of spinal cord injury, one of which did not present a deficit of strength or sensibility (ASIA E), but there were pyramidal signs and a history of falls. The other 4 had some degree of sensory-motor dysfunction, with ASIA score varying from A to D. Postoperative complications included two dehiscences of suture, one pneumothorax and one pneumonia, all with favorable evolution. Four patients progressed with neurological improvement and one of them had persistence of the neurological deficit until the last follow-up. Conclusions Multiple-level PVCR has proven to be a safe and effective option for the treatment of kyphotic deformity in spinal tuberculosis in children with neurological deficit. Level of evidence IV; Case Series.

scholarly journals Long-term outcomes of vertebral column resection for kyphosis in patients with cured spinal tuberculosis: average 8-year follow-up

2016 ◽  
Vol 24 (5) ◽  
pp. 777-785 ◽  
Author(s):  
Congcong Liu ◽  
Li Lin ◽  
Weixing Wang ◽  
Guohua Lv ◽  
Youwen Deng
Keyword(s):  
Sagittal Balance ◽  
Vertebral Column ◽  
Spinal Injury ◽  
Spinal Tuberculosis ◽  
Adjacent Segment ◽  
Kyphosis Angle ◽  
Analog Scale ◽  
Vertebral Column Resection

OBJECTIVE The authors conducted a study to evaluate the long-term clinical and radiographic outcomes of vertebral column resection (VCR) for kyphosis in patients with cured spinal tuberculosis. METHODS This was a retrospective study. Between 2003 and 2009, 28 consecutive patients with cured spinal tuberculosis underwent VCR for kyphosis in which the target vertebra was removed completely. Autologous iliac crest bone graft or titanium mesh packed with autograft was placed into the osteotomy gap to reconstruct the spine for anterior column stability. Posterior pedicle screw fixation and fusion were typically performed. Radiographic parameters, including kyphosis angle and sagittal balance, were measured, and visual analog scale score, America Spinal Injury Association grade, Scoliosis Research Society outcome instrument (SRS-22) score, Oswestry Disability Index, patient satisfaction index, and long-term complications were evaluated. RESULTS This study included 12 males and 16 females, with an average age of 20.9 years at the time of surgery. The average follow-up was 96.9 months. No deaths occurred in this study. At the final follow-up, the kyphosis angle improved from the preoperative average of 70.7° to the final follow-up average of 30.2°, and the average kyphosis correction loss was 8.5°. The sagittal balance averaged 15.4 mm before surgery, 2.8 mm after surgery, and 5.4 mm at the final followup. Thirteen patients showed improvement of more than 1 America Spinal Injury Association grade. The visual analog scale, Oswestry Disability Index, and SRS-22 scores improved significantly, and the overall satisfaction rate was 92.9%. Adjacent-segment degeneration occurred in 3 patients. No severe instrumentation-related complications were observed. CONCLUSIONS The long-term safety and efficacy of the VCR technique for treating spinal tuberculosis-related kyphosis were favorable, and no severe late-stage complications appeared. Lumbar tubercular kyphosis showed a tendency for sagittal decompensation within the first 3 postoperative years. Cases of adjacent-segment degenerations were relatively few and mild without clinical symptoms.

scholarly journals Intraoperative tension pneumothorax during posterior vertebral column resection in a child with congenital scoliosis

2019 ◽  
Vol 10 ◽  
pp. 155 ◽  
Author(s):  
Abolfazl Rahimizadeh ◽  
Valiollah Hassani ◽  
Nima Mohsenikabir ◽  
Ava Rahimizadeh ◽  
Mona Karimi ◽  
...  
Keyword(s):  
Vertebral Column ◽  
Pleural Cavity ◽  
Tension Pneumothorax ◽  
Congenital Scoliosis ◽  
Hemodynamic Instability ◽  
Urethral Catheter ◽  
Scoliosis Surgery ◽  
Surgical Team ◽  
Vertebral Column Resection ◽  
Posterior Vertebral Column Resection

Background:Intraoperative tension pneumothorax (TPT) is extremely rare in spinal surgery overall and particularly in extensive deformity procedures. Here, we report a TPT occurring in conjunction with posterior vertebral column resection (pVCR) for the treatment of congenital scoliosis.Case Description:A 12-year-old female undergoing congenital thoracic scoliosis surgery (e.g., pVCR) developed abrupt intraoperative increases in airway pressure and compromised hemodynamics that led to a TPT. This was directly attributed to an inadvertent pleural tear. Temporary drainage of the accumulated air was accomplished with a urethral catheter inserted directly into the pleural cavity. This was later supplemented with a standard chest tube. The child quickly improved and was routinely discharged a few days later.Conclusion:In patients undergoing pVCR, if the surgical team is faced with unexplained hemodynamic instability and increased airway resistance, a TPT should be strongly suspected and appropriately managed.

Posterior Vertebral Column Resection (PVCR) for Congenital Thoracic Lordoscoliosis in children under age of 10 with minimum 5 years follow-up

2017 ◽  
Vol 5 (6) ◽  
pp. 450
Author(s):  
Cem Sever ◽  
Sinan Kahraman ◽  
Selhan Karadereler ◽  
Lim Sze Wei ◽  
Tunay Sanli ◽  
...  
Keyword(s):  
Vertebral Column ◽  
Vertebral Column Resection ◽  
Posterior Vertebral Column Resection

scholarly journals Posterior hemivertebra resection and monosegmental fusion in the treatment of congenital scoliosis

2014 ◽  
Vol 96 (1) ◽  
pp. 41-44 ◽  
Author(s):  
X Zhu ◽  
X Wei ◽  
J Chen ◽  
C Li ◽  
M Li ◽  
...  
Keyword(s):  
Cobb Angle ◽  
Sagittal Plane ◽  
Congenital Scoliosis ◽  
Coronal Plane ◽  
X Ray ◽  
Hemivertebra Resection ◽  
The Mean ◽  
Whole Spine

INTRODUCTION Posterior hemivertebra resection combined with multisegmental or bisegmental fusion has been applied successfully for congenital scoliosis. However, there are several immature bones and their growth can be influenced by long segmental fusion in congenital patients. Posterior hemivertebra resection and monosegmental fusion was therefore suggested for treatment of congenital scoliosis caused by hemivertebra. METHODS Between June 2001 and June 2010, 60 congenital scoliosis patients (aged 2–18 years) who underwent posterior hemivertebra resection and monosegmental fusion were enrolled in our study. A standing anteroposterior x-ray of the whole spine was obtained preoperatively, postoperatively and at the last follow-up appointment to analyse the Cobb angle in the coronal and sagittal planes as well as the trunk shift. RESULTS The mean preoperative coronal plane Cobb angle was 41.6°. This was corrected to 5.1° postoperatively and 5.3° at the last follow-up visit (correction 87.3%). The compensatory cranial curve was improved from 18.1° preoperatively to 7.1° postoperatively and 6.5° at the last follow-up visit while the compensatory caudal curve was improved from 21.5° to 6.1° after surgery and 5.6° at the last follow-up visit. The mean sagittal plane Cobb angle was 23.3° before surgery, 7.3° after surgery and 6.8° at the last follow-up visit (correction 70.1%). The trunk shift of 18.5mm was improved to 15.2mm. CONCLUSIONS Posterior hemivertebra resection and monosegmental fusion seems to be an effective approach for treatment of congenital scoliosis caused by hemivertebra, allowing for excellent correction in both the frontal and sagittal planes.

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