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Comparison of Single-Level Versus Multilevel Vertebral Column Resection Surgery for Pediatric Patients With Severe Spinal Deformities

Hwang, Chang Ju, MD, PhD; Lenke, Lawrence G., MD; Sides, Brenda A., MA; Blanke, Kathy M., RN; Kelly, Michael P., MD

doi: 10.1097/BRS.0000000000002948

Study Design. Retrospective cohort of pediatric patients (younger than 21 years) with severe spinal deformities who underwent vertebral column resection (VCR) surgery.

Objective. To compare patients who underwent single- versus multilevel VCR surgery in terms of radiographic correction and perioperative complications.

Summary of Background Data. There are few studies comparing single- to multilevel VCR surgery regarding the efficacy and safety of the procedures.

Methods. Eighty-two pediatric patients who underwent a VCR for severe spinal deformity between 2002 and 2012 by one surgeon were included. A single-level VCR was performed in 45 patients with an average of 4.7-year follow-up, and multilevel VCR in 37 patients with an average of 4.6-year follow-up.

Results. Coronal Cobb corrections were not different between groups (single level: 63%, multilevel: 58%, P = 0.146). Correction loss at final follow-up did not differ (3.1° vs. 0.3°, P = 0.132). Patients in the single-level group had shorter operation times (9.2 vs. 10.5 hours, P = 0.046), whereas estimated blood loss did not differ between the two groups (1061 vs. 1200 mL, P = 0.181). The rate of spinal cord monitoring events was 20% (8/40) and 30% (9/30), respectively. No patient in the single-level group had a postoperative neurologic deficit, whereas three patients in the multilevel group experienced a temporary deficit postoperatively (0/45 vs. 3/37, P = 0.088).

Conclusion. There was no difference in radiographic correction between the single- and multilevel VCR groups. The multilevel VCR patients had longer operative times, and although the differences were not statistically significant due to low sample size, the multilevel VCR group also had an increased rate of postoperative neurologic deficits. We would recommend single-level VCRs unless there is an absolute indication for multilevel resection as in necessary decompression for spinal cord impingement.

Level of Evidence: 4

Patients who underwent single level vertebral column resection (VCR) surgery were compared with those who underwent multi-level VCR surgery. There was no difference in radiographic correction between single and multi-level VCR groups, however, the multi-level VCR group had longer operative times and a higher rate of postoperative neurologic deficits.

Department of Orthopaedic Surgery, Scoliosis Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Division of Spinal Surgery, Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY

Spinal Deformity Service, Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO.

Address correspondence and reprint requests to Lawrence G. Lenke, MD, The Daniel and Jane Och Spine Hospital, New York Presbyterian/Allen, 5141 Broadway, New York, NY 10034; E-mail:

Received 10 August, 2018

Accepted 30 October, 2018

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

No funds were received in support of this work.

Relevant financial activities outside the submitted work: board membership, consultancy, grants, royalties, expert testimony, travel/accommodations/meeting expenses.

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