VERTEBRAL COLUMN RESECTION BY POSTERIOR ONLY APPROACH FOR CORRECTION OF SEVERE RIGID KYPHOSIS – RETROSPECTIVE ANALYSIS OF SEVENTEEN PATIENTS
Authors: Dr. Pramod V. Lokhande, Dr. T. Date, Dr. N. Barkade, Dr. Mithun J
Authors Affiliations: SKN Medical College, Pune
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Study Design: A retrospective analysis of 17 patients with severe rigid kyphosis who underwent single or two staged deformity correction by vertebral column resection (VCR) by all posterior approach
Financial disclosures: None
17 patients having severe rigid kyphosis or Kyphoscoliosis of more than 55 degrees sagittal Cobb angle, who underwent deformity correction surgeryby a single surgeon P.L. between August 2009 to July 2013 were retrospectively reviewed.
Clinical & radiological records were reviewed &analyzed for
- Degree of Deformity
- Back pain
- Neurological status
- Spinal Balance – sagittal & coronal
There were 8 males and 9 females. Mean Age was 24.3 yrs (range = 9-53).
Average followup was 44.04 mths (18 – 66). There were 12 cases of Angular kyphosis and 5 cases of Globularkyphosis, 13 cases of Kyphosis and 4 cases of Kyphoscoliosis. Four patients had preoperative neurological deficit. 2 patients were ASIA C and 2 patients were ASIA D . 2 patients were previously operated elsewhere with worsening of symptoms.
Deformity correction was done by an all posteriorVCR with pedicle screw fixation and anteriorly placed titanium mesh cages or tricortical fibula grafts. Stagnara wake up test was used in all cases intraoperatively immediately after correction. Preoperative sagittal cobb angle was compared with immediate postoperative cobb angle and Cobb angle at final followup.Patients were followed up at 1, 3,6,12, 18 months. 2 yrs
The clinical results were evaluated for improvement in neurological status , spinal balance (both sagittal & coronal) and back pain using Oswestry Disability Index (ODI), visual analogue scale (VAS), and subjective satisfaction from surgery. There was significant improvement in the sagittal Cobb angle when compared with preoperative angle with minimal loss of correction at final follow up. Complications include one case of anterior cord syndrome which improved at one month followup to preoperative status, two cases of dural tears with CSF leaks which were managed intraoperatively. There was One case of proximal screws pullout with mild recurrence in kyphosis. One case of deep infection that responded well to debridement and antibiotics and one case of superficial infection that improved with intravenous antibiotics.
Vertebral column resection (VCR) by an all posterior approach is a safe but challenging technique for treating severe rigid kyphosis or kyphoscoliosis deformity. It allows dramatic clinical and radiological correction of these severely deformed patients
|How to Cite this Abstract|
|Lokhande P. VERTEBRAL COLUMN RESECTION BY POSTERIOR ONLY APPROACH FOR CORRECTION OF SEVERE RIGID KYPHOSIS – RETROSPECTIVE ANALYSIS OF SEVENTEEN PATIENTS. International Journal of Conference Proceedings. March 2015;(2015):23|