Complications after 147 consecutive vertebral column resections for severe pediatric spinal deformity: a multicenter...

Area of Science:

• Orthopedics
• Pediatric Spine Surgery
• Spinal Deformity Correction

Background:

• The precise definition, indications, and outcomes of vertebral column resection (VCR) for severe pediatric spinal deformity remain incompletely understood.
• A comprehensive multicenter review evaluating the numerous potential complications associated with VCR has not been previously performed.

Purpose of the Study:

• To define vertebral column resection (VCR).
• To determine the indications, results, and outcomes of VCR for severe pediatric spinal deformity.
• To specifically focus on the complications associated with this complex surgical procedure.

Main Methods:

• Retrospective multicenter review of 147 pediatric patients (average age 13.7 years) undergoing VCR by 7 surgeons.
• Patients had an average of 1.6 vertebrae resected and were followed for an average of 17 months.
• A strict definition of VCR was applied: a 3-column circumferential vertebral osteotomy creating a segmental defect requiring provisional instrumentation.

Main Results:

• Indications included kyphoscoliosis, severe scoliosis, congenital deformity, global kyphosis, and angular kyphosis.
• Significant radiographic correction was achieved across all deformity types, with average Cobb angle reductions ranging from 33° to 57°.
• The overall complication rate was 59%, including intraoperative neurological events in 27% of patients; however, no permanent paraplegia occurred. Average operative time was 545 minutes with 1610 mL estimated blood loss.

Conclusions:

• Vertebral column resection (VCR) in pediatric patients with severe spinal deformity yields excellent radiographic correction.
• The procedure is associated with a high complication rate (59%), highlighting its challenging nature.
• Careful patient selection and surgical planning are crucial due to the complexity and risks involved in VCR.