Posterior vertebral column resection in early onset spinal deformities.

Area of Science:

• Pediatric Orthopedics
• Spinal Surgery
• Skeletal Dysplasias

Background:

• Early onset spinal deformities (EOSD) pose life-threatening risks in young children.
• Surgical intervention is often necessary for spinal deformities impacting growth, pulmonary function, and balance.
• Posterior vertebral column resection (PVCR) is an established technique, but its application in very young children is less documented.

Purpose of the Study:

• To present the surgical experience with PVCR in children with EOSD.
• To describe the PVCR surgical technique tailored to the unique anatomy of young children.
• To evaluate the efficacy and safety of PVCR in this pediatric population.

Main Methods:

• Retrospective analysis of four children (mean age 3.7 years) with severe spinal deformity treated with PVCR.
• Single-approach posterior circumferential resection of vertebral bodies and posterior elements.
• Use of transpedicular screw-rod system for correction and stabilization, with fusion limited to the resection site.
• Intraoperative multimodal monitoring and postoperative radiographic assessment.

Main Results:

• Significant reduction in mean Cobb angle (scoliosis) from 69° to 29° and kyphosis from 126° to 61°.
• Mean scoliosis correction of 57% and kyphosis correction of 51%.
• No spinal cord-related complications; two patients experienced anesthesia complications and postoperative infection requiring further intervention.

Conclusions:

• PVCR is an effective surgical option for severe EOSD in young children.
• Adaptations in surgical technique are crucial for addressing the unique anatomy of young patients.
• Non-fusion instrumentation beyond the resection site is advantageous for accommodating spinal growth and future fusion procedures.