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Suk, Chung, Lee, Kim, Kim, Lee, Choi, and Park: Posterior Vertebral Column Resection (PVCR) in Fixed Lumbosacpal Deformity
Original Article

Journal of Korean Spine Surg 2004;11(2):90-98.

Published online: 12 February 2004

DOI: https://doi.org/10.4184/jkss.2004.11.2.90

Posterior Vertebral Column Resection (PVCR) in Fixed Lumbosacpal Deformity

Se-Il Suk, MD., Ewy-Ryong Chung, MD., Jung-Hee Lee, MD#, Jin-Hyok Kim, MD., Sung-Soo Kim, MD., Ji-Ho Lee, M.D§, Won-Kee Choi, MD., Yong-Won Park, MD.

Seoul Spine Institute, Inje University Sanggye Paik Hospital

#Department of Orthopaedic Surgery, National Medical Center

§Department of Orthopaedic Surgery, Boramae Municipal Hospital

Address reprint requests to Ewy-Ryong Chung, M.D. Department of Orthopaedic Surgery, Inje University Sanggye Baek Hospital, Sanggye 7 dong, Nowon-gu, Seoul 139-707, Korea Tel: 82-2-950-1288, Fax: 82-2-3392-1101, E-mail: dragon@sanggyepaik.ac.kr

Copyright © 2004 Korean Society of Spine Surgery

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

A retrospective study.

Objectives

To report the results and techniques of posterior vertebral column resections for fixed lumbosacral deformity.

Summary of Literature Review

Fixed lumbosacral deformity results in gross imbalance and progressive compensatory thoracolumbar deformity due to the absence of a mobile spine caudally.

Material and Methods

Twenty- five consecutive fixed lumbosacral deformity patients subjected to PVCR were reviewed after a minimum follow- up of 2 years. The offending vertebra was below the L4 in all cases. The etiological diagnoses were congenital scoliosis, congenital kyphoscoliosis, post-traumatic kyphosis and postinfectious kyphosis in 6, 3, 2 and 14 patients, respectively. The average age at the time of operation was 38 years, with a male:female ratio of 7:18. The indication for PVCR was fixed lumbosacral deformities that could not be brought to a reasonable balance on traction or forced side bending.

Results

On average 2.1, ranging from 1 to 5, vertebrae were removed, with 52 removed in all. The average fusion extent was 4.5 vertebrae, ranging from 2 to 8. A n anterior column reconstruction was carried out with an autogenous bone graft in all patients, with the additional insertion of titanium mesh in 12. The distal anchor went down to the L5, S1 and S2 in 4, 12 and 9 patients, respectively. A preoperative scoliosis of 3812 was corrected to 158 (60% correction), and a preoperative kyphosis of 3525 was corrected to - 511 (40% correction). A preoperative coronal imbalance of 2.0cm was improved to 0.9cm, and a preoperative sagittal imbalance of 9.3 cm was improved to 4.6 cm. The mean operation time and blood loss were 280 minutes and 2810ml, respectively. Following complications were encountered in 5 patients: 2 transient neurologies, 2 compression fractures at proximal adjacent vertebra and 1 pseudoarthrosis.

Conclusions

A posterior vertebral column resection is an effective procedure for the management of a fixed lumbosacral deformity. It provides satisfactory correction and improved functional outcomes. However, it is a technically demanding and exhausting procedure, with possible risks for complications

Keywords: lumbosacral deformity, posterior vertebral column resection (PVCR), pedicle screw fixation

REFERENCES

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Fig. 1.
Case 6. 41-year-old female with lumbosacral scoliosis and L5 hemivertebra. (A) Preoperative anteroposterior radiograph shows lumbosacral scoliosis of 25° and proximal compensatory curve of 33°. (B) Preoperative lateral radiograph. (C) Preioerative tomograph shows L5 hemivertebra. (D) Postoperative anteroposterior radiograph. She was treated with posterior vertebral column resection of L5 with interbody cage. The lumbosacral scoliosis is corrected to 6° and proximal compensatory curve is corrected to 6°. The trunk is balanced post-operatively. (E) Postoperative lateral radiograph.
jkss-11-90f1.tif
Fig. 2.
Case 25. 49-year-old female with post-infectious lumbosacral kyphosis.(A) Preoperative anteroposterior radi-ogra p hs.(B) Preoperative lateral radiograph shows lumbosacral kyphosis of 54° and sagittal imbalance of 10.5 cm.(C) Preoperative MRI shows neural compression at the apex of deformity.(D) Postoperative anteroposterior radiograph. (E) Postoperative lateral radiograph. She was treated with posterior vertebral column resection of L3,4,5 with interbody cage. The lumbosacral kyphosis is corrected to lordosis of 1°, and the trunk imbalance is corrected to 2.7 cm.
jkss-11-90f2.tif
Table 1.
Patient characteristics and surgical outcome
No Sex Age Dx∗ CP† F/U(month) Res. No.of RV‡ Ant.recons Distal anchor Cx∗∗
1 M 2.5 CS   76 L4 1 Chip bone L5  
2 F 34 CS P 56 L5 1 Chip bone S2  
3 M 9.9 CS   26 L5 1 Chip bone S1  
4 M 25 CS P 26 L56 2 Mesh S1  
5 M 8.9 CS   25 L4 1 Chip bone L5  
6 F 41 CS N, P 24 L5 1 Mesh S2  
7 F 35 CKS P 52 L5 1 Chip bone S2  
8 F 61 CKS N, P 46 L34 2 Mesh S2 Comp fx
9 M 16 CKS   28 L4 1 Mesh L5  
10 F 69 PTK P 73 L4 1 Chip bone S1  
11 F 61 PTK P 29 L4 1 Chip bone S1  
12 F 52 PIK N, P 73 L3 1 Chip bone L5  
13 F 36 PIK N 71 L1234 4 Chip bone S1 TN
14 F 37 PIK N, P 70 L1234 4 Chip bone S1  
15 F 44 PIK N, P 69 L234 3 Chip bone S1  
16 M 37 PIK P 65 L34 2 Chip bone S1  
17 F 38 PIK N, P 65 L12345 5 Mesh S2  
18 F 61 PIK N, P 65 L3 1 Mesh S1 NU
19 F 40 PIK P 60 L1234 4 Mesh S1  
20 M 61 PIK N, P 58 L5 1 Mesh S2 TN
21 F 40 PIK P 57 L345 3 Mesh S2  
22 F 60 PIK N, P 49 L45 2 Mesh S2 Comp fx
23 F 26 PIK P 44 L234 3 Mesh S1  
24 F 49 PIK N, P 26 L234 3 Chip bone S1  
25 F 49 PIK N, P 25 L345 3 Mesh S2  

∗ Dx = diagnosis; CS = congenital scoliosis; CKS = congenital kyphoscoliosis; PTK = post-traumatic kyphosis, PIK = post-infectious kyphosis.

† CP = clinical presentation; N = neurologic impairment; P = pain.

‡ No. of RV = Number of resected vertebra(e)

∗∗ Cx = complications; Comp fx = proximal adjacent compression fracture; TN = transient neurology; NU = non-union.

Table 2.
Coronal correction
No LS curve (°) Compensatory curve (°) Balance (cm)
Pre IMPO Last Net Pre IMPO Last Net Pre IMPO Last Net
1 26 4 3 23 8 1 2 6 1.0 0.2 0 1.0
2 37 16 18 19 40 15 23 17 3.5 1.6 2.3 1.2
3 40 14 16 24 7 4 4 3 1.5 0 0 1.5
4 29 8 10 19 40 14 15 25 3.5 1.2 1.2 2.3
5 35 12 12 23 8 6 3 5 0 0.2 0 0
6 25 6 6 19 33 8 6 27 1.2 0.5 0.6 0.6
7 37 18 18 19 47 30 33 14 6.0 2.8 3.0 3.0
8∗ 56 21 25 31 26 7 6 20 0 0.2 1.2 -1.2
9 57 30 28 29 28 8 14 14 1.0 0.1 0 1.0
Pre = preoperative; IMPO = at 2 weeks after surgery; Last = at most recent follow-up; Net = Pre-Last.

∗ with complication of proximal adjacent compression fracture.

Table 3.
Sagittal correction
No Regional kyphosis (°) Thoracic kyphosis (°) Lumbar lordosis (°) Balance (cm)
Pre IMPO Last Net Pre IMPO Last Net Pre IMPO Last Net Pre IMPO Last Net
7 0 -10 -8 8 5 10 10 5 -28 -30 -32 4 5.0 4.5 4.5 0.5
8∗ 53 -17 -16 69 4 11 24 20 47 -22 -18 65 16.5 8.4 11.1 5.4
9 15 -13 -11 26 20 23 22 2 -25 -36 -38 13 5.2 0.3 0 5.2
10 3 -20 -17 20 3 10 12 9 -10 -35 -30 20 3.0 0.8 2.1 0.9
11 9 -17 -15 24 15 20 20 5 -15 -32 -28 13 7.7 3.2 3.5 4.2
12 50 10 11 39 -3 18 23 26 10 -36 -38 48 4.0 1.3 2.0 2.0
13 60 12 18 42 -32 -10 -12 20 35 -14 -1 36 7.0 1.5 3.2 3.8
14 35 -5 -3 38 -37 -10 -11 26 23 -17 -13 36 9.5 0.5 1.0 8.5
15 58 -3 -2 60 -38 -15 -7 31 51 -3 0 51 14.1 6.2 6.7 7.4
16 0 -30 -30 30 -27 -5 0 27 -4 -35 -32 28 3.5 -3.8 0.5 3.0
17 64 -3 -1 65 -26 2 3 29 64 -3 -1 65 14.8 6.1 6.0 8.8
18† 10 10 10 0 -6 10 0 6 -5 -37 -25 20 21.0 8.5 20.1 0.9
19 55 -7 -7 62 -40 -18 2 42 55 -7 -7 62 3.3 -4.2 -0.9 4.2
20 18 0 0 18 16 20 22 6 -21 -39 -35 14 6.2 3.6 4.2 2.0
21 40 -10 -10 50 -35 -10 -10 25 27 -18 -12 39 10.9 4.5 4.8 6.1
22∗ 25 -7 -7 32 -20 2 -21 -1 20 -15 7 13 19.0 3.7 12.0 7.0
23 40 -6 -4 44 -23 3 5 28 40 -6 -4 44 4.3 0 2.5 1.8
24 84 0 2 82 -40 5 11 51 83 -4 -4 87 12.0 0 2.2 9.8
25 54 -3 -1 55 -40 -15 -15 25 32 -6 -5 37 10.5 0.9 2.7 7.8

Pre = preoperative; IMPO = at 2 weeks after surgery; Last = at most recent follow-up; Net = Pre-Last.

∗ with complication of proximal adjacent compression fracture.

† with complication of non-union.

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