Complications of Posterior Vertebral Resection for Spinal Deformity

STUDY DESIGN: Retrospective study. PURPOSE: To evaluate the incidence and risk factors of complications following posterior vertebral resection (PVR) for spinal deformity. METHODS: A review of 233 patients treated with PVR at one institution over a nine-year period (1997 to 2005) was performed. The average age was 33.5 years. Complications were assessed in terms of surgical techniques (posterior vertebral column resection [PVCR] and decancellation osteotomy) and etiologies of deformity. RESULTS: Local kyphosis was corrected from 51.4degrees to 2.7degrees, thoracic scoliosis 63.9degrees to 24.5degrees (62.6% correction), and thoracolumbar or lumbar scoliosis 50.1degrees to 17.1degrees (67.6%). The overall incidence of complications was 40.3%. There was no significant difference between PVCR and decancellation osteotomy in the incidence of complications. There were more complications in the older patients (>35 years) than the younger (p 0.05). There was 1 mortality case by heart failure. Revision surgery was performed in 15 patients for metal failure or progressing curve. CONCLUSIONS: The overall incidence of complications of PVR was 40.3%. Older age, abundant blood loss, preoperative kyphosis, and long fusion were risk factors for complications.

Posterior Hemivertebra Excision in Congenital Scoliosis / 대한척추외과학회지

STUDY DESIGN: Retrospective study OBJECTIVES: To evaluate the surgical outcome of congenital scoliosis with a hemivertebra treated by posterior hemivertebra excision and pedicle screw instrumentation. SUMMARY OF LITERATURE REVIEW: Posterior hemivertebra excision can be accomplished through a single posterior approach, and excellent correction and outcome may be achieved. MATERIALS AND METHODS: Forty patients with one fully segmented hemivertebra treated by posterior hemivertebra excision with pedicle screw instrumentation were retrospectively analyzed after a minimum follow-up of 2 years (range 2~7.7 years). The mean age at surgery was 15.9 years (range 2.6~37.9 years). Preoperative and postoperative standing radiographs were used to assess radiographic parameters. RESULTS: The average number of vertebrae in the major curve was 4.2 (range 3~8), and the average flexibility was 29% (range 8~59%). The average length of fusion was 3.5 segments (range 1~6). The number of fused vertebrae had a positive correlation with age at the index surgery (r=0.345, p<0.05). Mean preoperative scoliosis of 48+/-12degrees was corrected to a mean of 17+/-10degrees (65% correction), and mean preoperative kyphosis of 46+/-18degrees was corrected to a mean of 12+/-12degrees at the most recent follow-up. The compensatory curve had a mean of 25+/-10degrees preoperatively and spontaneously corrected to a mean of 8+/-8degrees (70% correction) at the most recent follow-up. The mean operating time was 233+/-81 min, with an average blood loss of 2904 ml. There was neither crankshaft phenomenon nor iatrogenic spinal stenosis in 6 patients under the age of 5 years after an average follow-up of 6 years. CONCLUSIONS: Posterior hemivertebra excision using pedicle screw instrumentation in congenital scoliosis due to a hemivertebra is a safe and effective procedure. Posterior hemivertebra excision at an early age may reduce the fusion length while avoiding the induction of iatrogenic spinal stenosis during follow-up.

Aprotinin Reduced Blood Loss in Spinal Deformity Surgery / 대한정형외과학회잡지

PURPOSE: Complications are quite common in surgery to correct spinal deformities due to the long duration under anesthesia and massive blood loss. The aim of this study was to evaluate and compare the effectiveness of Aprotinin in spinal deformity surgery. MATERIALS AND METHODS: Fifty-nine patients who underwent spinal deformity surgery were analyzed. Thirty-two patients were administered Aprotinin, and 27 control patients were not. The Pre- and Post- operative hemoglobin and hematocrit, blood loss, transfusion requirements, operative time, postoperative blood loss through suction drains and duration of suction drains were measured in both groups. RESULTS: There were no differences in age, gender, height, weight, hemodynamic indices, postoperative blood loss through the suction drains and the duration of the suction drains between the two groups. Intraoperative blood loss, transfusion and operative time were 1,345+/-425 cc, 1,008+/-721 cc, and 247 minutes in the Aprotinin (+) group and 2,070+/-1,276 cc, 2,552+/-2,791 cc, and 279 minutes in the Aprotinin (-) group, respectively. The postoperative hemoglobin and hematocrit levels were also significantly different (12.9+/-1 cc and 38.3+/-3.1% in the Aprotinin (+) group, and 11.9+/-1.8 cc and 35+/-5.5% in the Aprotinin (-) group, respectively). CONCLUSION: There was significantly less intraoperative blood loss, transfusion and surgery time in the group administered Aprotinin. Therefore, Aprotinin can be used in spinal deformity surgery that has a high risk of massive blood loss.