Complications after 147 consecutive vertebral column resections for severe pediatric spinal deformity: A multicenter analysis

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.