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Complications after 147 consecutive vertebral column resections for severe pediatric spinal deformity: a multicenter analysis.
Spine (Phila Pa 1976). 2013 Jan 15; 38(2):119-32.S

Abstract

STUDY DESIGN

Retrospective multicenter review.

OBJECTIVE

Determine the definition, indications, results, and outcomes, focusing on complications of vertebral column resection (VCR) for severe pediatric spinal deformity.

SUMMARY OF BACKGROUND DATA

The strict definition of the VCR procedure, indications, results, outcomes, and the numerous, potentially serious complications are unknown or controversial, and a large multicenter review has never been performed.

METHODS

A total of 147 patients treated by 7 pediatric spinal deformity surgeons were reviewed-seventy-four females and 73 males, with an average age of 13.7 years, an average of 1.6 (range, 1-5) vertebrae resected, and an average follow-up of 17 months (range, 0.5-64 mo). The strict definition of VCR used was a "3-column circumferential vertebral osteotomy creating a segmental defect with sufficient instability to require provisional instrumentation."

RESULTS

Indications for a VCR were divided into 5 diagnostic categories: kyphoscoliosis (n = 52), severe scoliosis (n = 37), congenital deformity (n = 28), global kyphosis (n = 17), and angular kyphosis (n = 13). Eighty-four primary and 63 revision patients with 174 operative procedures, 127 posterior-only (17 staged), and 20 patients combined anterior-posterior (10 staged) were reviewed. Average preoperative upright, flexibility, and postoperative Cobb measures (% correction or average kyphosis decrease) were kyphoscoliosis: 91°, 65°, 44° (51% coronal), 104°, 81°, and 47° (decrease, 57° sagittal); severe scoliosis: 104°, 78°, and 33° (67%); congenital deformity: 47°, 38°, 22° (46% coronal), 56°, 48°, and 32° (decrease, 24° sagittal); global kyphosis: 101°, 79°, and 47° (decrease, 54°); and angular kyphosis: 88°, 90°, and 38° (decrease, 50°), respectively. Operative time averaged 545 minutes (range, 204-1355 min) and estimated blood loss averaged 1610 mL (range, 50-8244 mL) for an average 65% blood volume loss (range, 6%-316%). Eighty-six patients (59%) developed a complication, 39 patients (27%) having an intraoperative neurological event (spinal cord monitoring change or failed wake-up test); however, no patient had complete permanent paraplegia.

CONCLUSION

A total of 147 consecutive pediatric VCRs performed by 7 surgeons demonstrated excellent radiographical correction. However, these complex reconstructions were associated with a 59% complication rate, thus emphasizing the challenging nature of these patients and procedures.

Authors+Show Affiliations

Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S Euclid Ave., St. Louis, MO, 63110, USA. lenkel@wudosis.wustl.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22825478

Citation

Lenke, Lawrence G., et al. "Complications After 147 Consecutive Vertebral Column Resections for Severe Pediatric Spinal Deformity: a Multicenter Analysis." Spine, vol. 38, no. 2, 2013, pp. 119-32.
Lenke LG, Newton PO, Sucato DJ, et al. Complications after 147 consecutive vertebral column resections for severe pediatric spinal deformity: a multicenter analysis. Spine (Phila Pa 1976). 2013;38(2):119-32.
Lenke, L. G., Newton, P. O., Sucato, D. J., Shufflebarger, H. L., Emans, J. B., Sponseller, P. D., Shah, S. A., Sides, B. A., & Blanke, K. M. (2013). Complications after 147 consecutive vertebral column resections for severe pediatric spinal deformity: a multicenter analysis. Spine, 38(2), 119-32. https://doi.org/10.1097/BRS.0b013e318269fab1
Lenke LG, et al. Complications After 147 Consecutive Vertebral Column Resections for Severe Pediatric Spinal Deformity: a Multicenter Analysis. Spine (Phila Pa 1976). 2013 Jan 15;38(2):119-32. PubMed PMID: 22825478.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Complications after 147 consecutive vertebral column resections for severe pediatric spinal deformity: a multicenter analysis. AU - Lenke,Lawrence G, AU - Newton,Peter O, AU - Sucato,Daniel J, AU - Shufflebarger,Harry L, AU - Emans,John B, AU - Sponseller,Paul D, AU - Shah,Suken A, AU - Sides,Brenda A, AU - Blanke,Kathy M, PY - 2012/7/25/entrez PY - 2012/7/25/pubmed PY - 2013/7/3/medline SP - 119 EP - 32 JF - Spine JO - Spine (Phila Pa 1976) VL - 38 IS - 2 N2 - STUDY DESIGN: Retrospective multicenter review. OBJECTIVE: Determine the definition, indications, results, and outcomes, focusing on complications of vertebral column resection (VCR) for severe pediatric spinal deformity. SUMMARY OF BACKGROUND DATA: The strict definition of the VCR procedure, indications, results, outcomes, and the numerous, potentially serious complications are unknown or controversial, and a large multicenter review has never been performed. METHODS: A total of 147 patients treated by 7 pediatric spinal deformity surgeons were reviewed-seventy-four females and 73 males, with an average age of 13.7 years, an average of 1.6 (range, 1-5) vertebrae resected, and an average follow-up of 17 months (range, 0.5-64 mo). The strict definition of VCR used was a "3-column circumferential vertebral osteotomy creating a segmental defect with sufficient instability to require provisional instrumentation." RESULTS: Indications for a VCR were divided into 5 diagnostic categories: kyphoscoliosis (n = 52), severe scoliosis (n = 37), congenital deformity (n = 28), global kyphosis (n = 17), and angular kyphosis (n = 13). Eighty-four primary and 63 revision patients with 174 operative procedures, 127 posterior-only (17 staged), and 20 patients combined anterior-posterior (10 staged) were reviewed. Average preoperative upright, flexibility, and postoperative Cobb measures (% correction or average kyphosis decrease) were kyphoscoliosis: 91°, 65°, 44° (51% coronal), 104°, 81°, and 47° (decrease, 57° sagittal); severe scoliosis: 104°, 78°, and 33° (67%); congenital deformity: 47°, 38°, 22° (46% coronal), 56°, 48°, and 32° (decrease, 24° sagittal); global kyphosis: 101°, 79°, and 47° (decrease, 54°); and angular kyphosis: 88°, 90°, and 38° (decrease, 50°), respectively. Operative time averaged 545 minutes (range, 204-1355 min) and estimated blood loss averaged 1610 mL (range, 50-8244 mL) for an average 65% blood volume loss (range, 6%-316%). Eighty-six patients (59%) developed a complication, 39 patients (27%) having an intraoperative neurological event (spinal cord monitoring change or failed wake-up test); however, no patient had complete permanent paraplegia. CONCLUSION: A total of 147 consecutive pediatric VCRs performed by 7 surgeons demonstrated excellent radiographical correction. However, these complex reconstructions were associated with a 59% complication rate, thus emphasizing the challenging nature of these patients and procedures. SN - 1528-1159 UR - https://www.unboundmedicine.com/medline/citation/22825478/Complications_after_147_consecutive_vertebral_column_resections_for_severe_pediatric_spinal_deformity:_a_multicenter_analysis_ L2 - https://doi.org/10.1097/BRS.0b013e318269fab1 DB - PRIME DP - Unbound Medicine ER -