TY - JOUR
T1 - Vertebral column resection in children with neuromuscular spine deformity
AU - Sponseller, Paul D.
AU - Jain, Amit
AU - Lenke, Lawrence G.
AU - Shah, Suken A.
AU - Sucato, Daniel J.
AU - Emans, John B.
AU - Newton, Peter O.
PY - 2012/5/15
Y1 - 2012/5/15
N2 - Study Design. Retrospective analysis. Objective. To determine, in pediatric patients with neuromuscular deformity undergoing vertebral column resection (VCR), the (1) characteristics of the surgery performed; (2) amount of pelvic obliquity restoration, and coronal and sagittal correction achieved; (3) associated blood loss and complications; and (4) extent to which curve type and VCR approach influenced correction, blood loss, and complications. Summary of Background Data. VCR allows for correction of severe, rigid spinal deformity. This technique has not been previously reported in children with neuromuscular disorders. Methods. We retrospectively reviewed the records of 23 children with neuromuscular disorders (mean age, 15 years) and spinal deformities (severe scoliosis, 9; global kyphosis or angular kyphosis, 4; kyphoscoliosis, 10) who underwent VCR. The Student t test was used to compare correction differences (statistical significance, P < 0.05). Results: A mean 1.5 vertebrae (27 thoracic and 6 lumbar) were resected per patient. Significant corrections were achieved in pelvic obliquity (11°, from 19°± 13°to 8°± 7°), in major coronal curve (56°, from 94°± 36°to 38°± 20°), and in major sagittal curve (46°, from 86°± 37°to 40°± 19°). There was no difference in correction between various curve types. VCR was associated with substantial blood loss (mean, 76% [estimated blood loss per total blood volume]), which correlated with patient weight and operating time. Overall, 6 patients experienced major complications: spinal cord injury, pleural effusion requiring chest tube insertion, pneumonia, pancreatitis, deep wound infection, and prominent implant requiring revision surgery. There were no deaths or permanent neurological injuries. Conclusion. VCR achieved significant pelvic obliquity restoration and coronal and sagittal correction in children with neuromuscular disorders and severe, rigid spinal deformity. However, this challenging procedure involves the potential for major complications.
AB - Study Design. Retrospective analysis. Objective. To determine, in pediatric patients with neuromuscular deformity undergoing vertebral column resection (VCR), the (1) characteristics of the surgery performed; (2) amount of pelvic obliquity restoration, and coronal and sagittal correction achieved; (3) associated blood loss and complications; and (4) extent to which curve type and VCR approach influenced correction, blood loss, and complications. Summary of Background Data. VCR allows for correction of severe, rigid spinal deformity. This technique has not been previously reported in children with neuromuscular disorders. Methods. We retrospectively reviewed the records of 23 children with neuromuscular disorders (mean age, 15 years) and spinal deformities (severe scoliosis, 9; global kyphosis or angular kyphosis, 4; kyphoscoliosis, 10) who underwent VCR. The Student t test was used to compare correction differences (statistical significance, P < 0.05). Results: A mean 1.5 vertebrae (27 thoracic and 6 lumbar) were resected per patient. Significant corrections were achieved in pelvic obliquity (11°, from 19°± 13°to 8°± 7°), in major coronal curve (56°, from 94°± 36°to 38°± 20°), and in major sagittal curve (46°, from 86°± 37°to 40°± 19°). There was no difference in correction between various curve types. VCR was associated with substantial blood loss (mean, 76% [estimated blood loss per total blood volume]), which correlated with patient weight and operating time. Overall, 6 patients experienced major complications: spinal cord injury, pleural effusion requiring chest tube insertion, pneumonia, pancreatitis, deep wound infection, and prominent implant requiring revision surgery. There were no deaths or permanent neurological injuries. Conclusion. VCR achieved significant pelvic obliquity restoration and coronal and sagittal correction in children with neuromuscular disorders and severe, rigid spinal deformity. However, this challenging procedure involves the potential for major complications.
KW - children
KW - neuromuscular scoliosis
KW - spine deformity
KW - vertebral column resection
UR - http://www.scopus.com/inward/record.url?scp=84861094378&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84861094378&partnerID=8YFLogxK
U2 - 10.1097/BRS.0b013e318244460d
DO - 10.1097/BRS.0b013e318244460d
M3 - Article
C2 - 22166930
AN - SCOPUS:84861094378
SN - 0362-2436
VL - 37
SP - E655-E661
JO - Spine
JF - Spine
IS - 11
ER -