Elias C Papadopoulos1, Oheneba Boachie-Adjei2, W Fred Hess3, Francisco J Sanchez Perez-Grueso4, Ferran Pellisé5, Munish Gupta6, Baron Lonner7, Kenneth Paonessa8, Michael Faloon9, Matthew E Cunningham2, Han Jo Kim2, Michael Mendelow10, Christina Sacramento11, Muharrem Yazici12. 1. University of Athens, School of Medicine, Ypsilantou 18 St., Athnens, 10676, Greece. Electronic address: hpapado@yahoo.com. 2. Hospital for Special Surgery, 226 East 54th Street, Suite 306, New York, NY 10022, USA. 3. Geisinger Medical Center, 100 North Academy Avenue, Danville, PA 17822-2201, USA. 4. Hospital De La Paz-Madrid, P(o) de la Castellana, 261 - 28046 Madrid, Spain. 5. Department of Orthopaedic Surgery, Hospital Universitario Vfafall d'Hebron, Passeig de la Vall d'Hebron, 119, 08035 Barcelona, Spain. 6. University of California-Davis, 2315 Stockton Blvd., Sacramento, CA 95817, USA. 7. NYU Hospital for Joint Diseases, 301 East 17th St., New York, NY 10003, USA. 8. Norwich Orthopedic Group, North Franklin, 82 New Park Ave., North Franklin, CT 06254, USA. 9. Seton Hall University-St. Joseph's Children's Hospital, 703 Main St., Paterson, NJ 07503, USA. 10. Shriners Hospitals for Children, 950 West Faris St., Greenville, SC 29605, USA. 11. University Hospital of Canarias, Ctra. Ofra S/N La Cuesta, 38320 La Laguna, Spain. 12. Hacettepe University, Medical Faculty 06100 Sıhhiye, Ankara, Turkey.
Abstract
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.
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.
Authors: Jamal N Shillingford; Joseph L Laratta; Nana O Sarpong; Rami G Alrabaa; Meghan K Cerpa; Ronald A Lehman; Lawrence G Lenke; Charla R Fischer Journal: J Spine Surg Date: 2019-03