Analysis Of Perioperative Complications And Risk Factors Of Posterior Vertebral Column Resection For Severe Spinal Deformities

Background and Objective:Severe kyphoscoliosis is a complicated3-dimensional deformity of spine.Conventional surgical treatments are incapable to achieve satisfactory correction because of the large Cobb and the rigidness of deformities.Usually,these patients need osteotomy,or even vertebral column resection to correct the rigid deformity.Since Suk and colleagues(2002) reported a posterior-only approach with a vertebral column resection (VCR) for severe, rigid scoliosis.this technique has been used widely at home and abroad,and has accomplished good corrective effects. However, it is a highly technical procedure,and it’s complications are common.And the incidence of neurological complications is high,while the results of which are serious.The reported incidence of complications of one-staged posterior VCR was25%～48.8%(mean39%).And the neurological complications’ average incidence is11.8%,and the permanent neurological injury’s is1.4-6.25%.To analyze the perioperative complications of one stage posterior VCR for severe spinal deformities and discuss the related risk factors.we retrospectively researched the data of39patients with serve spine deformity who undertook the one-staged posterior VCR from september,2004to july,2012.The purposes of this study were (1) to identify the type and incidence of posterior VCR’s peri-operation complications,(2) to analysis the related risk factors of complications,and (3) to come up with the prevention and treatment strategies for the peri-operational complications.Materials and methods: From September2004to July2012,39consecutive caes(15males,24females)of severe and fixed spinal deformities managed by one-stage posterior VCR with transpedicular instrumentation.The age of the group were from3to53years old,with the average age of16.9years.There were29patients at age less than18years old and10at age more than18years old.Patients were divided into four pathological types:kyphoscoliosis group(n=24.mean scoliosis85.1°,and mean kyphosis92.9°),scoliosis group (n=7,mean scoliosis81.1°),kyphosis group(n=8,mean kyphosis94.4°).Of all the patients,33patients underwent primary surgery and6underwent revision surgery.There were11patients with preoperative neurological compromise.Surgical methods included posterior apex vertebral resection,segemental pedicle screw fixation and correction as well as vertebral reconstruction.A retrospective analysis on perioperative complications and related risk factors of39patients was performed.Results:All of the39patients were followed up for3to72months(average,29.4months).There were15cases (13patients) of perioperative complications caused by one-stage posterior VCR.Neurological complications occurred in6cases (15.4%),among whom one patient presented complete paraplegia after surgery and5presented transient paresthesia or muscle weakness.The incidence rate was36.4%for patients with preoperative neurological compromise and7.1%for patients without preoperative neurological compromise (P<0.05).The adult group had a high rate of neurological complications(P<0.05).All of the patients with neurological deficits had kyphosis and the incidence rate of severe kyphosis(≥90°) was high(P<0.05).4cases needed prolonged respiratory support,the incidence rate was10.3%.Preoperative pulmonary dysfunction group had a higher rate of prolonged respire support(P<0.05).3cases (7.7%) of parietal pleura reptured,1case (2.6%) of cerebrospinal fluid leakage,and1case (2.6%) of pulmonary infection.Conclusion:One stage posterior VCR is effective in the treatment of severe and rigid spinal deformities.However, surgeons should pay enough attention to the perioperative complications, especially the neurological complication.The risk factors for neurology complication include preoperative neurologic compromise,the angle of kyphosis and the patients’ age.Preoperative pulmonary dysfunction is a risk factor for prolonged respire support.