Vertebral Column Resection for the Treatment of Severe... : Clinical Orthopaedics and Related Research® (original) (raw)

SYMPOSIUM: PEDIATRIC SPINE

Lenke, Lawrence G. MD1, a; Sides, Brenda A. MA1; Koester, Linda A. BS1; Hensley, Marsha RN2; Blanke, Kathy M. RN1

1Department of Orthopaedic Surgery, Washington University School of Medicine, Campus Box 8233, 660 S Euclid Avenue, 63110, St Louis, MO, USA

2Shriners Hospital for Children, St Louis, MO, USA

ae-mail; [email protected]

Received: October 2, 2008/Accepted: July 28, 2009/Published online: September 1, 2009

One or more of the authors receives institutional/research/grant support from Medtronic.

Each author certifies that his or her institution has approved the human protocol for this investigation, all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

Electronic supplementary material The online version of this article (doi:10.1007/s11999-009-1037-x) contains supplementary material, which is available to authorized users.

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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.

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