A single posterior approach for vertebral column resection in adults with severe rigid kyphosis

 Abstract Background: Correction of severe kyphosis is a challenging operation in spinal surgery. A two stage operation has been commonly used: anterior release and decompression followed by posterior correction and fusion. We describe the posterior vertebral osteotomy technique for correction of severe and rigid kyphosis through posterior-only approach. Methods: Twelve patients (six male and six female ) with severe and rigid kyphotic deformity of the thoracic spine were treated by posterior vertebral column resection using a single posterior approach. The apex level of kyphosis was at the upper thoracic in five patients, the lower thoracic in four patients and mid thoracic in three patients. There was old fracture in one patient, congenital deformity in six, tumor in three and neurofibromatosis in two patients. After posterior vertebral column resection, segmental posterior instrumentation was used for  correction of the kyphotic deformity. Complications and radiographic findings were analyzed to evaluate clinical outcomes and radiologic changes of posterior vertebral column resection in patients with angulated kyphotic deformity. Results: The major curve correction was averaged 31.66 ° (SD=15.69) (45%). The resection was performed at the involve level in every patient. Posterior segmental fusion was achieved in average 8.9 (SD=1.7) segments. Anterior reconstruction was with titanium mesh cage in two and with cancellous chip packing in other patients. There were no neurologic complications after six month. Bony fusion achieved in all patients, and there was no correction loss. Conclusion: Satisfactory correction is safely performed by posterior vertebral column resection with a direct visualization of the circumferentially decompressed spinal cord. Although the performance is technically laborious, it offers good correction without jeopardizing the integrity of the spinal cord.