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Updated: Jan 12, 2026
Modified Posterior Vertebral Column Resection for Patients with Thoracolumbar Kyphotic Deformity
Published on: September 16, 2022
Repeated Vertebral Column Resection (Re-VCR) in Congenital Scoliosis With Curve Progression After Instrumentation
Yinkun Li1,2, Wanyou Liu2, Benlong Shi1,2
1Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Clinical College of Nanjing Medical University, Nanjing, China.
Objective:
To evaluate the surgical efficacy of repeated vertebral column resection (Re-VCR) after instrumentation removal in congenital scoliosis (CS) patients previously undergoing primary posterior spinal correction with VCR, and to analyze complications pertinent to revision surgery.
Methods:
In this retrospective cross-sectional study, a total of 16 CS patients who underwent Re-VCR following instrumentation removal between February 2013 and February 2022 were reviewed. Radiographic parameters were assessed pre- and post-primary operation, pre-removal, pre- and post-revision and at the last follow-up. Clinical data were also analyzed and recorded for each patient.
Results:
The indications for instrumentation removal were infection, implant failure, patient and family request, and persistent pain. The Cobb angle of the main curve, global kyphosis (GK), coronal balance (CB) and sagittal vertical axis (SVA) significantly progressed after instrumentation removal. The average progression rates of scoliosis and kyphosis were 5.3° ± 4.0°/year and 10.0° ± 7.2°/year. Following revision surgery, the Cobb angle of the main curve, GK, CB showed significant improvement (t = 10.694, p < 0.001; Z = -3.516, p < 0.001; Z = -2.664, p = 0.008). For Re-VCR, the average extension of the fusion level was 2.9 ± 1.4 vertebrae proximally, 3.0 (2.0, 3.0) vertebrae distally and 5.4 ± 1.6 vertebrae in total. The average correction rates of the Cobb angle of the main curve and GK were 59.5% ± 23.4% and 53.7% ± 18.3% with no significant correction loss during follow-up (p > 0.05). Compared with pre-revision, the mean scores of pain, satisfaction, mental health and self-image on the Scoliosis Research Society-22 (SRS-22) questionnaire improved at different levels. Intra-revision complications included alert of neurophysiological monitoring and dural tear, while breakage of the distal L5 pedicle screw occurred in 1 (6.3%) patient 2 years after revision.
Conclusions:
Severe progression of deformity and trunk imbalance was frequently observed following instrumentation removal. The removal of instrumentation is not routinely recommended, and revision surgery employing Re-VCR frequently necessitates an extension of the fusion level. Satisfactory radiographic and clinical outcomes following Re-VCR were effectively maintained throughout the follow-up period, but great caution should be exercised during Re-VCR.
