Abstract
Introduction
Anterior thoracolumbar spine surgery is typically indicated for restoration of structural stability and /or decompression of neural element secondary to trauma, tumor or infection. But postoperative complications especially kyphosis poses distinct challenges to the spinal surgeon. The aim of this study was to explore the effects of posterior vertebral column resection of thoracolumbar kyphosis after failed anterior instrumented fusion.
Material and Methods
A retrospective study was conducted of 10 patients of kyphotic deformity with previous failed anterior surgery in our department from October 2005 to December 2009. The indications for revision surgery included pain refractory to conservative treatment, progressive neurological deficit and kyphosis. Anterior removal of the implant and posterior vertebral column resection (PVCR) was performed. Mean operating time, average intraoperative blood loss, kyphosis angle, the visual analog scale (VAS), Oswestry disability index (ODI), bone fusion time and complications were used for clinical assessment in a minimum 18-month follow-up (18 – 60 months).
Results
The mean age was 38.7 years old (ranging from 24 to 56 years old) and the average kyphosis angle was 54.60 (ranging from 45 0 to 74 0). Mean operating time was 323.5 (range 245 minute to 420 minute) with average intraoperative blood loss of 1189 ml (range 850 ml to 1550 ml). After revision surgery, Kyphosis angle was 4.800 (range3- 70) immediately and 6.80 (range 5 to 90) at the 18 months follow-up and there was good bony fusion in every case. The average time of bony fusion was 6.8 months (range 5–9 months). All patients had satisfied spinal sagittal and coronal balance at the last follow-up. None of our patients experienced implant failure. The average preoperative VAS was 6.2, falling to 2.6 at the 18 months follow-up with significant improvement. None of the patients suffered any surgery-related neurological deterioration and one patient whose neurological status was Frankel Grade C improved to Grade D. The ODI changed form a mean value of 39.8 (rang 31–48) preoperatively to 24.5 (rang 15–29) at the final follow-up. The difference was statistically significant. Complications occurred in four patients (40%); these included three with tearing of the lung and one with a superficial wound infection.
Conclusion
Despite the technically demanding procedure, anterior removal of the implant and posterior vertebral column resection was a safe and effective revision surgery for patients with prior anterior fusion with rigid post-surgical deformities.