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Vertebral Column Resection in Children With Neuromuscular Spine Deformity

Sponseller, Paul D., MD*; Jain, Amit, BS*; Lenke, Lawrence G., MD; Shah, Suken A., MD; Sucato, Daniel J., MD, MS§; Emans, John B., MD[BULLET OPERATOR]; Newton, Peter O., MD

doi: 10.1097/BRS.0b013e318244460d
Deformity
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Study Design. Retrospective analysis.

Objective. To determine, in pediatric patients with neuromuscular deformity undergoing vertebral column resection (VCR), the (1) characteristics of the surgery performed; (2) amount of pelvic obliquity restoration, and coronal and sagittal correction achieved; (3) associated blood loss and complications; and (4) extent to which curve type and VCR approach influenced correction, blood loss, and complications.

Summary of Background Data. VCR allows for correction of severe, rigid spinal deformity. This technique has not been previously reported in children with neuromuscular disorders.

Methods. We retrospectively reviewed the records of 23 children with neuromuscular disorders (mean age, 15 years) and spinal deformities (severe scoliosis, 9; global kyphosis or angular kyphosis, 4; kyphoscoliosis, 10) who underwent VCR. The Student t test was used to compare correction differences (statistical significance, P < 0.05).

Results. A mean 1.5 vertebrae (27 thoracic and 6 lumbar) were resected per patient. Significant corrections were achieved in pelvic obliquity (11°, from 19° ± 13° to 8° ± 7°), in major coronal curve (56°, from 94° ± 36° to 38° ± 20°), and in major sagittal curve (46°, from 86° ± 37° to 40° ± 19°). There was no difference in correction between various curve types. VCR was associated with substantial blood loss (mean, 76% [estimated blood loss per total blood volume]), which correlated with patient weight and operating time. Overall, 6 patients experienced major complications: spinal cord injury, pleural effusion requiring chest tube insertion, pneumonia, pancreatitis, deep wound infection, and prominent implant requiring revision surgery. There were no deaths or permanent neurological injuries.

Conclusion. VCR achieved significant pelvic obliquity restoration and coronal and sagittal correction in children with neuromuscular disorders and severe, rigid spinal deformity. However, this challenging procedure involves the potential for major complications.

Vertebral column resection is a challenging procedure that can be effectively used to treat severe, rigid spinal deformities in children with neuromuscular conditions. Although it is associated with potential severe complications, it allows appropriate spinal shortening and significant coordinated correction of coronal curve, sagittal curve, and pelvic obliquity.

*Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD;

Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO;

Department of Orthopaedic Surgery, Alfred I. duPont Hospital for Children, Wilmington, DE;

§Department of Orthopaedic Surgery, Texas Scottish Rite Hospital for Children, Dallas, TX;

[BULLET OPERATOR]Department of Orthopaedic Surgery, Children's Hospital Boston, Boston, MA; and

Department of Orthopaedic Surgery, Rady Children's Hospital and Health Center, San Diego, CA.

Address correspondence and reprint requests to Paul D. Sponseller, MD, c/o Elaine P. Henze, BJ, ELS, Medical Editor and Director, Editorial Services, Department of Orthopaedic Surgery, The Johns Hopkins University/Johns Hopkins Bayview Medical Center, 4940 Eastern Ave., #A665, Baltimore, MD 21224; E-mail: ehenze1@jhmi.edu.

Acknowledgment date: June 1, 2011. First revision date: August 26, 2011. Second revision date: October 12, 2011. Third revision date: November 7, 2011. Acceptance date: November 15, 2011.

The manuscript submitted does not contain information about medical device(s)/drug(s).

John and Marcella Fox Fund funds were received in support of this work.

One or more of the author(s) has/have received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this manuscript: e.g., honoraria, gifts, consultancies, royalties, stocks, stock options, decision-making position.

© 2012 Lippincott Williams & Wilkins, Inc.