Geoffrey E Stoker1, Lawrence G Lenke2, Michael P Kelly1. 1. Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8233, Saint Louis, MO 63110, USA. 2. Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8233, Saint Louis, MO 63110, USA. Electronic address: lenkel@wudosis.wustl.edu.
Abstract
BACKGROUND CONTEXT: Congenital dislocation of the spine (CDS) is a rare condition. Invariably, sagittal or coronal vertebral translation and an angulated neural canal exist. Mechanical instability, encroachment on the canal by the involved vertebrae, and coexistent spinal cord malformations have all been implicated in CDS-related neurologic deficit. Single-level vertebrectomy through a posterior midline approach has been recently described as first-line surgical intervention for CDS. PURPOSE: To illustrate the use of multilevel posterior vertebral column resection (pVCR) for the postsurgical revision of CDS-centered spinal deformity. DESIGN: Case report. METHODS: Review of 2 cases in which CDS was reconstructed with pVCR. RESULTS: A 6-year-old boy developed a 104° cervicothoracic kyphosis and myelopathy. An 11-year-old boy male developed a 92° thoracolumbar deformity but experienced only back pain. Both patients had undergone previous in situ fusion for CDS, and both presented with progressive, rigid, angular kyphosis. Two-level pVCRs were performed. At ultimate follow-up, imaging revealed sagittal correction of 75° (72%) in the 6-year-old child and 64° (70%) in the 11-year-old, and both were neurologically intact. CONCLUSIONS: Multilevel pVCR is a technically demanding but feasible option for the treatment of CDS that has proven recalcitrant to in situ fusion.
BACKGROUND CONTEXT: Congenital dislocation of the spine (CDS) is a rare condition. Invariably, sagittal or coronal vertebral translation and an angulated neural canal exist. Mechanical instability, encroachment on the canal by the involved vertebrae, and coexistent spinal cord malformations have all been implicated in CDS-related neurologic deficit. Single-level vertebrectomy through a posterior midline approach has been recently described as first-line surgical intervention for CDS. PURPOSE: To illustrate the use of multilevel posterior vertebral column resection (pVCR) for the postsurgical revision of CDS-centered spinal deformity. DESIGN: Case report. METHODS: Review of 2 cases in which CDS was reconstructed with pVCR. RESULTS: A 6-year-old boy developed a 104° cervicothoracic kyphosis and myelopathy. An 11-year-old boy male developed a 92° thoracolumbar deformity but experienced only back pain. Both patients had undergone previous in situ fusion for CDS, and both presented with progressive, rigid, angular kyphosis. Two-level pVCRs were performed. At ultimate follow-up, imaging revealed sagittal correction of 75° (72%) in the 6-year-old child and 64° (70%) in the 11-year-old, and both were neurologically intact. CONCLUSIONS: Multilevel pVCR is a technically demanding but feasible option for the treatment of CDS that has proven recalcitrant to in situ fusion.