Introduction: Vertebral column resection (VCR), consisting of posterior vertebral body excision along with the adjacent disks, is used for correction of severe pediatric deformity. This is the first multicenter study to examine the underlying condition necessitating surgery, immediate correction rates, operative time, blood loss, and neurological complications, to standardize indications and inform surgeons of perioperative neurological morbidities.
Methods: A retrospective chart review of patients who underwent a VCR for pediatric deformity between 2003 and 2008 was performed. Patients were divided into 5 deformity categories: 1) neuromuscular/paralytic (N/P); 2) complex congenital (CC); 3) adolescent idiopathic (AIS); 4) kyphosis (K); and 5) congenital hemivertebra (CH). Radiographic outcomes and intraoperative data are reported.
Results: Data was available for 31 of 33 consecutive patients. Major curve correction averaged 63° (56%) in the N/P group, 36° (46%) in the CC group, 44° (60%) in the AIS group, 44° (57%) in the K group, and 25° (55%) in the CH group. Operative time averaged 439 minutes in groups 1–4 (N/P, CC, AIS, K) and 249 minutes in group 5 (CH). Blood loss averaged 1870 cc in groups 1–4 and 760 cc in group 5 (CH). Groups 1–4 demonstrated intraoperative spinal cord MEP and/or SSEP monitoring changes in 8 of 18 (44%) patients; 3 postoperative lower extremity (LE) partial motor deficits resulted (1 resolved and 2 with ongoing recovery). Group 5 demonstrated monitoring changes in 2 of 13 (15%) patients; 1 postoperative unilateral LE deficit fully resolved.
Conclusion: VCR is a valuable deformity surgery technique with potential neurological complications that can be minimized by the use of spinal cord monitoring to guide intraoperative decisions. VCR risks appear less when performed for hemivertebra excision. Intraoperative neuromonitoring changes are common and the surgeon should be prepared to make adjustments accordingly.