J Korean Soc Spine Surg.  2004 Jun;11(2):90-98. 10.4184/jkss.2004.11.2.90.

Posterior Vertebral Column Resection (PVCR) in Fixed Lumbosacpal Deformity

• Suk SI
• Chung ER
• Lee JH
• Kim JH
• Kim SS
• Lee JH
• Choi WK
• Park YW

• KMID: 2097815
• DOI: http://doi.org/10.4184/jkss.2004.11.2.90

Abstract

STUDY DESIGN: A retrospective study.
OBJECTIVES
To report the results and techniques of posterior vertebral column resections for fixed lumbosacral deformity. SUMMARY OF LITERATURE REVIEW: Fixed lumbosacral deformity results in gross imbalance and progressive compensatory thora-columbar deformity due to the absence of a mobile spine caudally. MATERIAL AND METHODS: Twenty-five consecutive fixed lumbosacral deformity patients subjected to PVCR were reviewed after a minimum follow-up of 2 years. The offending vertebra was below the L4 in all cases. The etiological diagnoses were congenital scoliosis, congenital kyphoscoliosis, post-traumatic kyphosis and post-infectious kyphosis in 6, 3, 2 and 14 patients, respectively. The average age at the time of operation was 38 years, with a male:female ratio of 7:18. The indication for PVCR was fixed lumbosacral deformities that could not be brought to a reasonable balance on traction or forced side bending.
RESULTS
On average 2.1, ranging from 1 to 5, vertebrae were removed, with 52 removed in all. The average fusion extent was 4.5 vertebrae, ranging from 2 to 8. An anterior column reconstruction was carried out with an autogenous bone graft in all patients, with the additional insertion of titanium mesh in 12. The distal anchor went down to the L5, S1 and S2 in 4, 12 and 9 patients, respectively. A preoperative scoliosis of 3812 was corrected to 158 (60% correction), and a preoperative kyphosis of 3525 was corrected to -511 (40% correction). A preoperative coronal imbalance of 2.0cm was improved to 0.9cm, and a preoperative sagittal imbalance of 9.3 cm was improved to 4.6 cm. The mean operation time and blood loss were 280 minutes and 2810ml, respectively. Following complications were encountered in 5 patients: 2 transient neurologies, 2 compression fractures at proximal adjacent vertebra and 1 pseudoarthrosis.
CONCLUSIONS
A posterior vertebral column resection is an effective procedure for the management of a fixed lumbosacral deformity. It provides satisfactory correction and improved functional outcomes. However, it is a technically demanding and exhausting procedure, with possible risks for complications

Keyword

lumbosacral deformity; posterior vertebral column resection (PVCR); pedicle screw fixation

MeSH Terms

Congenital Abnormalities*
Diagnosis
Follow-Up Studies
Fractures, Compression
Humans
Kyphosis
Pseudarthrosis
Retrospective Studies
Scoliosis
Spine*
Titanium
Traction
Transplants
Titanium

Figure

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  Fig. 1. Case 6. 41-year-old female with lumbosacral scoliosis and L5 hemivertebra. (A) Preoperative anteroposterior radiograph shows lumbosacral scoliosis of 25° and proximal compensatory curve of 33°. (B) Preoperative lateral radiograph. (C) Preioerative tomograph shows L5 hemivertebra. (D) Postoperative anteroposterior radiograph. She was treated with posterior vertebral column resection of L5 with interbody cage. The lumbosacral scoliosis is corrected to 6° and proximal compensatory curve is corrected to 6°. The trunk is balanced post-operatively. (E) Postoperative lateral radiograph.

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  Fig. 2. Case 25. 49-year-old female with post-infectious lumbosacral kyphosis.(A) Preoperative anteroposterior radi-ogra p hs.(B) Preoperative lateral radiograph shows lumbosacral kyphosis of 54° and sagittal imbalance of 10.5 cm.(C) Preoperative MRI shows neural compression at the apex of deformity.(D) Postoperative anteroposterior radiograph. (E) Postoperative lateral radiograph. She was treated with posterior vertebral column resection of L3,4,5 with interbody cage. The lumbosacral kyphosis is corrected to lordosis of 1°, and the trunk imbalance is corrected to 2.7 cm.

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