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Complications After 147 Consecutive Vertebral Column Resections for Severe Pediatric Spinal Deformity: A Multicenter Analysis

Lenke, Lawrence G., MD*; Newton, Peter O., MD; Sucato, Daniel J., MD, MS; Shufflebarger, Harry L., MD§; Emans, John B., MD; Sponseller, Paul D., MD; Shah, Suken A., MD**; Sides, Brenda A., MA*; Blanke, Kathy M., RN*

doi: 10.1097/BRS.0b013e318269fab1
Deformity
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Study Design. Retrospective multicenter review.

Objective. Determine the definition, indications, results, and outcomes, focusing on complications of vertebral column resection (VCR) for severe pediatric spinal deformity.

Summary of Background Data. The strict definition of the VCR procedure, indications, results, outcomes, and the numerous, potentially serious complications are unknown or controversial, and a large multicenter review has never been performed.

Methods. A total of 147 patients treated by 7 pediatric spinal deformity surgeons were reviewed—seventy-four females and 73 males, with an average age of 13.7 years, an average of 1.6 (range, 1–5) vertebrae resected, and an average follow-up of 17 months (range, 0.5–64 mo). The strict definition of VCR used was a “3-column circumferential vertebral osteotomy creating a segmental defect with sufficient instability to require provisional instrumentation.”

Results. Indications for a VCR were divided into 5 diagnostic categories: kyphoscoliosis (n = 52), severe scoliosis (n = 37), congenital deformity (n = 28), global kyphosis (n = 17), and angular kyphosis (n = 13). Eighty-four primary and 63 revision patients with 174 operative procedures, 127 posterior-only (17 staged), and 20 patients combined anterior-posterior (10 staged) were reviewed. Average preoperative upright, flexibility, and postoperative Cobb measures (% correction or average kyphosis decrease) were kyphoscoliosis: 91°, 65°, 44° (51% coronal), 104°, 81°, and 47° (decrease, 57° sagittal); severe scoliosis: 104°, 78°, and 33° (67%); congenital deformity: 47°, 38°, 22° (46% coronal), 56°, 48°, and 32° (decrease, 24° sagittal); global kyphosis: 101°, 79°, and 47° (decrease, 54°); and angular kyphosis: 88°, 90°, and 38° (decrease, 50°), respectively. Operative time averaged 545 minutes (range, 204–1355 min) and estimated blood loss averaged 1610 mL (range, 50–8244 mL) for an average 65% blood volume loss (range, 6%–316%). Eighty-six patients (59%) developed a complication, 39 patients (27%) having an intraoperative neurological event (spinal cord monitoring change or failed wake-up test); however, no patient had complete permanent paraplegia.

Conclusion. A total of 147 consecutive pediatric VCRs performed by 7 surgeons demonstrated excellent radiographical correction. However, these complex reconstructions were associated with a 59% complication rate, thus emphasizing the challenging nature of these patients and procedures.

The use of vertebral column resection for severe pediatric spinal deformity in 147 consecutive patients revealed excellent radiographical correction and improved clinical outcomes but with a 59% overall complication rate and a 27% incidence of intraoperative neurological events, thus emphasizing the serious and challenging nature of these complex procedures.

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

Department of Orthopaedic Surgery, Rady Children's Hospital, San Diego, CA

Department of Orthopaedic Surgery, Texas Scottish Rite Hospital, Dallas, TX

§Department of Orthopaedic Surgery, Miami Children's Hospital, Miami, FL

Department of Orthopaedic Surgery, Children's Hospital, Harvard Medical School, Boston, MA

Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD; and

**Department of Orthopaedic Surgery, Alfred I. DuPont Hospital for Children, Wilmington, DE.

Address correspondence and reprint requests to Lawrence G. Lenke, MD, Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S Euclid Ave., Campus Box 8233, St. Louis, MO, 63110; E-mail: lenkel@wudosis.wustl.edu

Acknowledgment date: February 9, 2012. Revision date: June 12, 2012. Acceptance date: June 20, 2012.

The device(s)/drug(s) is/are FDA approved or approved by corresponding national agency for this indication.

Washington University Fox funds were received to support 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.

© 2013 Lippincott Williams & Wilkins, Inc.