Pediatric Posterior Vertebral Column Resection (PVCR): Before and After Ten Years of Age Greater Than 10-Year Follow-Up

Study Design. A retrospective study. Objective. To compare the surgical outcomes of posterior vertebral column resection (PVCR) and its long-term effects on the deformity correction for congenital scoliosis in children less than 18 years of age. Summary of Background Data. There have been no reports on surgical outcomes that pertain to the timing of surgery for congenital scoliosis in children under age 18 years with long term follow-up. Methods. Forty-five congenital scoliosis patients (N = 45) under age 18 at the time of surgery were treated by PVCR. These cases were retrospectively studied and had a minimum 10-year follow-up. We assigned patients into two groups: Group 1 (N = 19) patients who had surgery before 10 years of age, Group 2 (N = 26) patients who had surgery after 10 years of age. Results. In Group 1, the mean Cobb angle of the main curve was 44° before surgery, 10.2° after surgery, and 14.2° at last follow-up. In Group 2, the mean Cobb angle of the main curve was 48.7° before surgery, 17.2° after surgery, and 20.4° at the last follow-up. The mean operative time was 189 minutes in Group 1 and 245 minutes in Group 2. The mean estimated blood loss (EBL) per kilogram was 52.9 mL/kg in Group 1 and 48.1 mL/kg in Group 2. There were 22 complications for PVCR and the overall prevalence of complications was 48.9%. Conclusion. PVCR is an effective procedure for the management of congenital scoliosis under age 18. PVCR for congenital scoliosis before the age of 10 years had significantly better deformity correction compared with the group after the age of 10 years and did not cause crankshaft phenomenon. Level of Evidence: 4

[1]  J. Mooney,et al.  The Crankshaft Phenomenon. , 2017, The Journal of the American Academy of Orthopaedic Surgeons.

[2]  Samuel K. Cho,et al.  Posterior vertebral column resection in spinal deformity: a systematic review , 2016, European Spine Journal.

[3]  Quan-qing Li,et al.  Causes of the failure and the revision methods for congenital scoliosis due to hemivertebra , 2015, Congenital anomalies.

[4]  K. Ha,et al.  Surgical outcomes by age at the time of surgery in the treatment of congenital scoliosis in children under age 10 years. , 2015, The spine journal : official journal of the North American Spine Society.

[5]  Munish C. Gupta,et al.  Early outcomes and complications of posterior vertebral column resection. , 2015, The spine journal : official journal of the North American Spine Society.

[6]  K. Ha,et al.  Posterior Hemivertebra Resection and Short Segment Fusion With Pedicle Screw Fixation for Congenital Scoliosis in Children Younger Than 10 Years: Greater Than 7-Year Follow-up , 2015, Spine.

[7]  K. Ha,et al.  How to Improve Shoulder Balance in the Surgical Correction of Double Thoracic Adolescent Idiopathic Scoliosis , 2014, Spine.

[8]  M. Mcmaster,et al.  Prognosis for congenital scoliosis due to a unilateral failure of vertebral segmentation. , 2013, The Journal of bone and joint surgery. American volume.

[9]  L. Lenke,et al.  Complications After 147 Consecutive Vertebral Column Resections for Severe Pediatric Spinal Deformity: A Multicenter Analysis , 2013, Spine.

[10]  R. Dunn,et al.  Posterior vertebral column resection for severe spinal deformities , 2013 .

[11]  X. Weng,et al.  Posterior hemivertebra resection with bisegmental fusion for congenital scoliosis: more than 3 year outcomes and analysis of unanticipated surgeries , 2013, European Spine Journal.

[12]  A. Alanay,et al.  Short-term X-ray Results of Posterior Vertebral Column Resection in Severe Congenital Kyphosis, Scoliosis, and Kyphoscoliosis , 2012, Spine.

[13]  X. Zou,et al.  Hemivertebra resection and scoliosis correction by a unilateral posterior approach using single rod and pedicle screw instrumentation in children under 5 years of age , 2011, Journal of pediatric orthopedics. Part B.

[14]  Zu-de Liu,et al.  Posterior unilateral pedicle subtraction osteotomy of hemivertebra for correction of the adolescent congenital spinal deformity. , 2011, The spine journal : official journal of the North American Spine Society.

[15]  B. Tosun,et al.  Isolated Pedicle Screw Instrumented Correction for the Treatment of Thoracic Congenital Scoliosis , 2010, Journal of spinal disorders & techniques.

[16]  L. Lenke,et al.  Vertebral Column Resection for the Treatment of Severe Spinal Deformity , 2010, Clinical orthopaedics and related research.

[17]  L. Lenke,et al.  Posterior Vertebral Column Resection for Severe Pediatric Deformity: Minimum Two-Year Follow-up of Thirty-Five Consecutive Patients , 2009, Spine.

[18]  J. Harms,et al.  Hemivertebra Resection and Osteotomies in Congenital Spine Deformity , 2009, Spine.

[19]  M. Proctor,et al.  Three Rod Technique Facilitates Hemivertebra Wedge Excision in Young Children Through a Posterior Only Approach , 2009, Spine.

[20]  T. Morley,et al.  Short anterior instrumented fusion and posterior convex non-instrumented fusion of hemivertebra for congenital scoliosis in very young children , 2008, European Spine Journal.

[21]  J. Emans,et al.  Congenital scoliosis: a review and update. , 2007, Journal of pediatric orthopedics.

[22]  G. Bollini,et al.  Thoracolumbar Hemivertebrae Resection by Double Approach in a Single Procedure: Long-term Follow-up , 2006, Spine.

[23]  G. Bollini,et al.  Lumbar hemivertebra resection. , 2006, The Journal of bone and joint surgery. American volume.

[24]  Jung-Hee Lee,et al.  Posterior Vertebral Column Resection in Fixed Lumbosacral Deformity , 2005, Spine.

[25]  W. Choi,et al.  Posterior Vertebral Column Resection for Severe Rigid Scoliosis , 2005, Spine.

[26]  I. Makhoul,et al.  Hemivertebra: Prenatal Diagnosis, Incidence and Characteristics , 2005, Fetal Diagnosis and Therapy.

[27]  S. Suk,et al.  Pedicle Screw Fixation in Pediatric Spinal Deformities - Results for patients under 10 years old - , 2005 .

[28]  R. Campbell,et al.  Congenital scoliosis. , 2004, Medical science monitor : international medical journal of experimental and clinical research.

[29]  J. Harms,et al.  Posterior Hemivertebra Resection With Transpedicular Instrumentation: Early Correction in Children Aged 1 to 6 Years , 2003, Spine.

[30]  J. Harms,et al.  Pedicle Screws in 1- and 2-Year-Old Children: Technique, Complications, and Effect on Further Growth , 2002, Spine.

[31]  J. Harms,et al.  Hemivertebra Resection by a Posterior Approach: Innovative Operative Technique and First Results , 2002, Spine.

[32]  Hiroaki Nakamura,et al.  Single-Stage Excision of Hemivertebrae Via the Posterior Approach Alone for Congenital Spine Deformity: Follow-up Period Longer Than Ten Years , 2002, Spine.

[33]  C. K. Lee,et al.  Segmental Pedicle Screw Fixation in the Treatment of Thoracic Idiopathic Scoliosis , 1995, Spine.

[34]  J. Dubousset,et al.  The Crankshaft Phenomenon , 1989, Journal of pediatric orthopedics.

[35]  R. Winter,et al.  Posterior spinal arthrodesis for congenital scoliosis. An analysis of the cases of two hundred and ninety patients, five to nineteen years old. , 1984, The Journal of bone and joint surgery. American volume.

[36]  M. Mcmaster,et al.  The natural history of congenital scoliosis. A study of two hundred and fifty-one patients. , 1982, The Journal of bone and joint surgery. American volume.

[37]  R. Nasca,et al.  Progression of congenital scoliosis due to hemivertebrae and hemivertebrae with bars. , 1975, The Journal of bone and joint surgery. American volume.