Cecilia L Dalle Ore1, Christopher P Ames1, Vedat Deviren2, Darryl Lau3. 1. Department of Neurological Surgery, University of California, San Francisco, California, USA. 2. Department of Orthopedic Surgery, University of California, San Francisco, California, USA. 3. Department of Neurological Surgery, University of California, San Francisco, California, USA. Electronic address: darryl.lau@ucsf.edu.
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.
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: Jake M McDonnell; Shane R Evans; Daniel P Ahern; Gráinne Cunniffe; Christopher Kepler; Alexander Vaccaro; Ian D Kaye; Patrick B Morrissey; Scott C Wagner; Arjun Sebastian; Joseph S Butler Journal: Eur Spine J Date: 2022-09-30 Impact factor: 2.721
Authors: Rushikesh S Joshi; Darryl Lau; Justin K Scheer; Miquel Serra-Burriel; Alba Vila-Casademunt; Shay Bess; Justin S Smith; Ferran Pellise; Christopher P Ames Journal: Spine Deform Date: 2021-05-18