Outcomes Following Single-Stage Posterior Vertebral Column Resection for Severe Thoracic Kyphosis.

Abstract

INTRODUCTION:

Thoracic kyphosis can result in neurologic deficits, pain, and cardiopulmonary dysfunction. Vertebral column resection (VCR) is a powerful technique that can be employed for large curves and fixed deformities. This study reports the outcomes of posterior VCR for adult spinal deformity with severe thoracic kyphosis.

METHODS:

A retrospective review of all patients with adult spinal deformity who underwent posterior VCR for severe thoracic kyphosis (defined as segmental kyphosis greater than 80°) was performed. Patients with kyphosis secondary to trauma, tumor, or infection were excluded. Perioperative, radiographic, and minimum 2-year outcomes were assessed.

RESULTS:

Nineteen patients were included. Mean age was 57.1 years and 31.6% were male. Mean preoperative sagittal vertical axis was 57.7 mm and thoracic kyphosis was 92.2°. Among 19 patients, 24 VCR were performed. Mean blood loss was 2188 mL. Perioperative complication rate was 36.8% and mortality rate was 5.3%. Mean postoperative sagittal vertical axis was 42.3 mm and thoracic kyphosis was 58.1°. Incidence of junctional failure at 2-year follow-up was 14.8%: 1 proximal and 2 distal. All patients with junctional disease required reoperation. At mean 35.7-month follow-up, 61.1% of patients reported a significant reduction of back pain and 50.0% were able to reduce their dose of opioid medications.

CONCLUSIONS:

Single-stage posterior VCR is a powerful technique for the correction of severe thoracic kyphosis. Perioperative morbidity can be high, but a majority of patients fare well at follow-up. Junctional disease occurs both proximal and distal; surgeons should continue to implement strategies to minimize distal junctional disease.

• Authors: Cecilia L Dalle Ore, Christopher P Ames, Vedat Deviren, Darryl Lau
• Journal: World neurosurgery (World Neurosurg) Vol. 119 Pg. e551-e559 (Nov 2018) ISSN: 1878-8769 [Electronic] United States
• PMID: 30077025 (Publication Type: Journal Article)
• Copyright: Copyright © 2018 Elsevier Inc. All rights reserved.

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Back Pain (diagnostic imaging, etiology, therapy)
• Diskectomy (methods)
• Female
• Follow-Up Studies
• Humans
• Kyphosis (complications, diagnostic imaging, surgery)
• Male
• Middle Aged
• Reoperation
• Retrospective Studies
• Thoracic Vertebrae (diagnostic imaging, surgery)
• Treatment Outcome
• Young Adult