Posterior vertebral column resection in spinal deformity: a systematic review

Purpose

This study aimed to assess the amount of correction and risk of complications of posterior vertebral column resection (PVCR) in the treatment of spinal deformity.

Methods

A comprehensive research was conducted in MEDLINE, EMBASE and Cochrane Database of Systematic Reviews for published articles about PVCR in spinal deformity. Data from these included studies were pooled with the help of the Review Manager software from the Cochrane Collaboration and the R software. The amount of correction of PVCR was indicated with change of coronal and sagittal Cobb angle after operation. Risk of complications was demonstrated with prevalence.

Results

7 studies, a total of 390 patients, were included for analysis. The average operative time for PVCR was 430 min and the estimated blood loss was 2,639 ml. The mean amount of correction by PVCR was 64.1° in scoliosis and 58.9° in kyphosis, accounting a correction rate of 61.2 and 63.1 %, respectively. As to coronal and sagittal imbalance, data were limited. The overall prevalence of complications of PVCR was 32 % (95 % CI 12–54 %). The most common was neurologic complications, estimated to be 8 % (95 % CI 2–16 %). And risk of spinal cord injury was 2 % (95 % CI 0–3 %). The revision rate was 6 % (95 % CI 1–13 %). Incidence of infection was pooled to be 2 % (95 % CI 1–4 %). Complication rate related with implant was 2 % (95 % CI 0–6 %).

Conclusion

PVCR is a powerful surgical procedure for severe spinal deformity. However, it has the risk of excessive blood loss and major complications. Decision of PVCR should be prudent and the procedure should be performed by an experienced surgical team.