TY - JOUR
T1 - Early outcomes and complications of posterior vertebral column resection
AU - Foundation of Orthopedics and Complex Spine
AU - Papadopoulos, Elias C.
AU - Boachie-Adjei, Oheneba
AU - Hess, W. Fred
AU - Sanchez Perez-Grueso, Francisco J.
AU - Pellisé, Ferran
AU - Gupta, Munish
AU - Lonner, Baron
AU - Paonessa, Kenneth
AU - Faloon, Michael
AU - Cunningham, Matthew E.
AU - Kim, Han Jo
AU - Mendelow, Michael
AU - Sacramento, Christina
AU - Yazici, Muharrem
N1 - Funding Information:
Author disclosures: ECP: Nothing to disclose. OB-A: Royalties: Depuy (C), K2M (C); Consulting: K2M (C), Depuy (C), Osteotech (B), Trans 1 (C); Speaking and/or Teaching Arrangements: K2M (C), Trans 1 (C); Research Support (Investigator Salary, Staff/Materials): K2M (C), Depuy (C) and Osteotech (B). WFH: Nothing to disclose. FJSP-G: Trips/Travel: DePuy (B); Research Support (Investigator Salary): DePuy: K2M Inc. (B, Paid directly to institution/employer); Research Support (Staff/Materials): DePuy: K2M Inc. (B, Paid directly to institution/employer). FP: Trips/Travel: DePuy Spine J&J (C, Paid directly to institution/employer); Consulting: DePuy Spine J&J (B); Grant: DePuy Spine J&J (F, Paid directly to institution/employer). MG: Royalties: Depuy (G); Stock Ownership: Johnson and Johnson (200 shares), Pfizer (300 shares), Pioneer (D), Proctor and Gamble (100 shares); Consulting: Depuy (C), Medtronic (B), Osteotech (A); Board of Directors: FOSA Treasurer; Fellowship Support: OREF (E), Synthes (E). BL: Royalties: DePuy Spine (G); Stock Ownership: Paradigm Spine (9272 units), Spine Search (5 units); Private Investments: Paradigm (E); Board of Directors: Spine Search; Scientific Advisory Board: DePuy Spine; Other Office: DePuy Spine; Grants: Setting Scoliosis Straight Foundation (D), AO Spine (D), John and Marcella Fox Fund Grant (B), OREF (C); Consultant: DePuy Spine (D). KP: Trips/Travel: K2M Inc. (B, Paid directly to institution/employer); Research Support (Investigator Salary): K2M Inc. (B, Paid directly to institution/employer); Research Support (Staff/Materials): K2M Inc. (B, Paid directly to institution/employer). MF: Nothing to disclose. MEC: Nothing to disclose. HJK: Nothing to disclose. MM: Provision of writing assistance, medicines, equipment, or administrative support: K2M Inc., DePuy Spine for equipments for the work implants; Consulting: DePuy Spine (B); Board of Directors: Volunteer FOCUS. CS: Nothing to disclose. MY: Consulting: K2M Inc. (B); Speaking/Teaching Arrangements: DePuy (B).
Publisher Copyright:
© 2015 Elsevier Inc. All rights reserved.
PY - 2015/5/1
Y1 - 2015/5/1
N2 - Background context: Hyperkyphosis confers a significant risk for neurologic deterioration as well as compromised cardiopulmonary function. Posterior vertebral column resection (PVCR) is a challenging but effective technique for spinal cord decompression and deformity correction that even under the setting of limited resources can be performed to reduce the technical difficulties, the operating time, and possibly the complications of the traditional two-staged vertebral column resection (VCR). Purpose: To report on the results of VCR performed through a single posterior approach (PVCR) in the treatment of severe rigid kyphosis in a series of patients treated and followed at a Scoliosis Research Society Global Outreach Program site in West Africa. Study design: Retrospective case series. Patient sample: Forty-five consecutive patients treated with PVCR for correction of severe rigid kyphosis. Outcome measures: Clinical and radiographic outcomes and complications; Scoliosis Research Society outcome instrument (SRS-22). Methods: From 2002 to 2009, 45 patients (20 male and 25 female) underwent PVCR for kyphosis from congenital deformity (nine) or secondary to tuberculosis of the spine (36). Preoperative demographics, preop and postop neurologic status, SRS-22 scores and complications were recorded; upright full spine X-rays were available in all patients. Mean age was 14 years (6-47 years); mean follow-up 27 months (2-79 months). Mean preoperative kyphosis measured 108°. The deformity apex was resected via a costotransverse (thoracic) or posterolateral (lumbar) approach; neurosurveillance with sensory (somatosensory-evoked potentials) and motor (motor-evoked potentials) potential was used in all cases. Posterior instrumentation was used in all patients, and anterior structural cage was used in 32 patients. Results: Intraoperative monitoring changes occurred in 10 patients (22%), and one patient progressed to complete spinal cord injury. Average preoperative local kyphosis was 108° and corrected to 600 postoperatively. Postoperatively, no additional patient showed neurologic deterioration; of the 11 patients with preoperative gait disturbances, 4 improved to normal gait, 5 remained the same, and 2 showed deterioration of their walking ability to nonambulating level. Total SRS-22 scores improved from 3.18 to 3.54 (p=.01), primarily self-image domain. Conclusions: Posterior vertebral column resection was successfully undertaken for the management of thoracic and thoracolumbar hyperkyphosis, demonstrating improvements in overall kyphosis and clinical outcome. Neuromonitoring provided the required safety to perform these challenging complex spine deformity procedures.
AB - Background context: Hyperkyphosis confers a significant risk for neurologic deterioration as well as compromised cardiopulmonary function. Posterior vertebral column resection (PVCR) is a challenging but effective technique for spinal cord decompression and deformity correction that even under the setting of limited resources can be performed to reduce the technical difficulties, the operating time, and possibly the complications of the traditional two-staged vertebral column resection (VCR). Purpose: To report on the results of VCR performed through a single posterior approach (PVCR) in the treatment of severe rigid kyphosis in a series of patients treated and followed at a Scoliosis Research Society Global Outreach Program site in West Africa. Study design: Retrospective case series. Patient sample: Forty-five consecutive patients treated with PVCR for correction of severe rigid kyphosis. Outcome measures: Clinical and radiographic outcomes and complications; Scoliosis Research Society outcome instrument (SRS-22). Methods: From 2002 to 2009, 45 patients (20 male and 25 female) underwent PVCR for kyphosis from congenital deformity (nine) or secondary to tuberculosis of the spine (36). Preoperative demographics, preop and postop neurologic status, SRS-22 scores and complications were recorded; upright full spine X-rays were available in all patients. Mean age was 14 years (6-47 years); mean follow-up 27 months (2-79 months). Mean preoperative kyphosis measured 108°. The deformity apex was resected via a costotransverse (thoracic) or posterolateral (lumbar) approach; neurosurveillance with sensory (somatosensory-evoked potentials) and motor (motor-evoked potentials) potential was used in all cases. Posterior instrumentation was used in all patients, and anterior structural cage was used in 32 patients. Results: Intraoperative monitoring changes occurred in 10 patients (22%), and one patient progressed to complete spinal cord injury. Average preoperative local kyphosis was 108° and corrected to 600 postoperatively. Postoperatively, no additional patient showed neurologic deterioration; of the 11 patients with preoperative gait disturbances, 4 improved to normal gait, 5 remained the same, and 2 showed deterioration of their walking ability to nonambulating level. Total SRS-22 scores improved from 3.18 to 3.54 (p=.01), primarily self-image domain. Conclusions: Posterior vertebral column resection was successfully undertaken for the management of thoracic and thoracolumbar hyperkyphosis, demonstrating improvements in overall kyphosis and clinical outcome. Neuromonitoring provided the required safety to perform these challenging complex spine deformity procedures.
KW - Congenital
KW - Kyphosis
KW - PVCR
KW - Posterior vertebral column resection
KW - Postinfectious
UR - http://www.scopus.com/inward/record.url?scp=84937969739&partnerID=8YFLogxK
U2 - 10.1016/j.spinee.2013.03.023
DO - 10.1016/j.spinee.2013.03.023
M3 - Article
C2 - 23623509
AN - SCOPUS:84937969739
SN - 1529-9430
VL - 15
SP - 983
EP - 991
JO - Spine Journal
JF - Spine Journal
IS - 5
ER -