Vertebral Column Resection through Posterior Approach in Rigid Adult Scoliosis / 대한척추외과학회지

ABSTRACT

OBJECTIVES: To report the surgical technique and effectiveness in treating rigid adult scoliosis with one stage vertebral column resection and pedicle screw fixation through a single posterior approach(PVCR). MATERIALS AND METHODS: Twenty-one patients with low flexibility(less than 20~30%) subjected to PVCR were evaluated after a mean follow-up of 18.5 months(12~29 months). There were 10 males and 11 females. The mean age at the time of the operation was 32.1 years(19~61 years). Etiological diagnoses were idiopathic in 7, congenital in 12, neuromuscular in 2. Preoperatively, all the patients showed moderate to severe derangement of pulmonary function with reduced vital capacity(30%~57%). RESULTS: An average of 1.3 vertebrae(1~3 vertebrae) were removed. The resection of body was in thoracic in 12 and lumbar in 15. Posterior fusion was carried out in 6.8(3~12) levels. Following the surgery, preoperative thoracic scoliosis of 86degree(55~130degree) and lumbar scoliosis of 64degree( 35~110degree) were corrected to 38degree(15~65degree) and 25degree(14~61degree), showing a correction of 56.2%(39~78%) and 61.1% (44~82%) respectively. Preoperative kyphosis of 59degree(16~104degree) was corrected to 24degree(2~58degree), showing a correction of 60.2%(41~74%). Preoperative coronal imbalance and shoulder height difference was corrected to 0.6 cm and 1.0 cm respectively. The average operation time and transfusion were 253 minutes and 2835 ml. The complications comprised two transient neurological deficits, one aggravated neurological deficits, one monoparesis, one infection, and one pneumothorax. CONCLUSIONS: One stage posterior vertebral column resection is a promising new technique for rigid scoliosis, significantly reducing the operative time and morbidity of combined anterior-posterior resection.