Outcomes of vertebral column resection in rigid, severe adult and pediatric spinal deformities

Study Design: Retrospective cohort study. Objectives: Managing severe and rigid spinal deformities is challenging to correct. Vertebral column resection (VCR) is often necessary for adequate correction. Substantial risks remain with blood loss, prolonged operative time, and risk to the neural elements. We studied VCR in rigid spinal deformities, including deformity correction, intraoperative neurophysiological monitoring (IONM) alerts, spinal cord/nerve injuries, and perioperative adverse events. Methods: We conducted a retrospective review of 55 patients who underwent VCR for severe and rigid spinal deformities with minimum 2 years of follow-up. Demographic data, diagnosis, comorbidities, radiographic parameters, and all adverse events were collected. Results: Twenty-four pediatric patients and 31 adult patients underwent VCR for rigid, severe scoliosis, kyphosis, or short angular deformities. The average Cobb angle for scoliotic deformities was 106.9°, ranging from 66° to 131°. The average angle of kyphosis was 90.6° (78°–108°). The average flexibility index was 15.7% ±10.9%. Two of pediatric cases and 11 of adult cases were revisions. The average postoperative correction rate was 68%. The average estimated blood loss was 1066 ml (150–5500 ml). Seven dural tears were repaired with no short-or long-term sequelae. Four of seven patients who had dural tear were revision cases. The incidence (30%) of dural tear in revision cases was significantly higher than primary cases. Six (10.9%) patients had IONM alerts during the surgery. None of the patients suffered from a spinal cord injury with a neurologic deficit. Conclusions: VCR can be a safe and effective option for correcting rigid and severe spinal deformities as demonstrated by this series.