Modified Posterior Vertebral Column Resection for Patients with Thoracolumbar Kyphotic Deformity

Summary

We describe a modified technique for resecting the posterior vertebral column unilaterally based on a modified trephine for patients with thoracolumbar kyphotic deformity.

Abstract

Old compression vertebrae fracture or congenital kyphoscoliosis with abnormal vertebral body development and other diseases that invade the spine may cause severe thoracolumbar kyphotic deformity, often accompanied by intractable low back pain or compression of the spinal cord, leading to severe neurological symptoms or even paralysis. If conservative treatment cannot relieve the symptoms or correct the deformities, surgical treatment is usually needed. For severe kyphotic deformity, reconstruction of the physiological curvature and rigid fixation determine the prognosis of the patients. Osteotomy and orthopedics are the standard procedure for deformities with severe compression of the front and middle column, but the trauma to the patients is high, with a long operation time and massive blood loss. To avoid these disadvantages, we have developed a modified technique to remove the diseased vertebra unilaterally. In this technique, we use a modified trephine to resect the vertebral columns like in the pedicle screw technique by adding a locking instrument that can restrict the trephine to lower the risk of osteotomy and shorten the surgery time and blood loss.

Introduction

Thoracolumbar kyphotic deformity is a primary or secondary disease generally caused by vertebrae fracture, vertebral body development, ankylosing spondylitis, and spinal tuberculosis^1,2,3,4. Severe kyphotic deformity often induces spinal cord compression or severe low back pain. Once conservative treatment becomes ineffective, a surgical approach is necessary due to the complications caused by the deformity. However, the appropriate surgical treatment remains controversial.

The surgical approach to treat severe ky....

Protocol

The protocol follows the guidelines of the Ethics Committee of the Third Hospital of Hebei Medical University. Informed consent was obtained from the patients for including them and the data generated as a part of this study.

1. Pre-operative preparation

1. Select patients according to the following inclusion and exclusion criteria. For the patients undergoing the surgeries, the inclusion criteria are as follows: 1) nerve compression due to thoracolumbar kyphosis, 2) severe low back pain due to kyphosis, 3) patients with Kummell disease, 4) kyphosis deformity left over by a cured infectious disease. The exclusion c....

Results

About 330° decompression can be achieved by using the unilateral PVCR technique. The transverse process and the rib head need to be removed to make sure the abduction angle is enough to remove the contralateral bone.

By using the modified trephine, the bone of the diseased vertebrae can be removed easily by rotating it with mild stress. When the trephine is locked, one should pull out the trephine and probe together, and then a cylinder of cancellous bone can be obtained (.......

Discussion

The steps of placing the temporary fixation rod and the deformity correction mentioned in the protocol are the critical steps during the surgery. By preserving one side of the pedicle and loading a temporary fixation bar, stability is preserved during the osteotomy procedure. During the surgical progress of the deformity correction, the nerve roots must be protected to prevent serious postoperative neurological complications. If the surgeons are uncertain about the location of the nerve roots, the exposure of the nerve r.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Adhesive	Biatain	3420	12.5 cm x 12.5 cm
Bipolar electrocoagulation tweezers	Juan'en Medical Devices Co.Ltd	BZN-Q-B-S	1.2 mm x 190 mm
Bone wax	ETHICON	W810T	2.5g
Curette	Qingniu	20739.01	300 x Ø9 x 5°
Double jointed forceps	SHINVA	286920	240 mm x 8 mm
High frequency active electrodes	ZhongBangTianCheng	GD-BZ	GD-BZ-J1
Laminectomy rongeur	Qingniu	2054.03	220 x 3.0 x 130°
Laminectomy rongeur	Qingniu	2058.03	220 x 5.0 x 130°
Pedicle screw	WEGO	800386545	6.5 mm x 45 mm
Pedicle screw	WEGO	800386550	6.5 mm x 50 mm
Pituitary rongeur	Qingniu	2028.01	220 mm x 3.0 mm
Pituitary rongeur	Qingniu	2028.02	220 mm x 3.0 mm
Rod	WEGO	800386040	5.5 mm x 500 mm
Surgical drainage catheter set	BAINUS MEDICAL	SY-Fr16-C	100-400 mL
Surgical film	3L	SP4530	45 cm x 30 cm
Titanium cage	WEGO	9051228	19 mm x 80 mm
Trephine	NATON MEDICAL GROUP	DJD04130	12 mm/10 mm