Posterior Vertebral Column Resection (pVCR) for Severe Thoracolumbar Kyphosis in Patients With Achondroplasia.

STUDY

DESIGN

Retrospective cohort study.

OBJECTIVE

We aimed to evaluate the safety and validity of posterior vertebral column resection (pVCR) for severe thoracolumbar kyphosis (TLK) in the achondroplasia (ACH) patients.

METHODS

Seven ACH patients (male: female = 6:1) who underwent pVCR procedures due to severe TLK from December 2008 to December 2017 in the authors' hospital were included in this retrospective study. Their mean follow-up duration was 67 ± 35 months. Their clinical characteristics, radiologic characteristics, surgical characteristics and surgical complications were reviewed.

RESULTS

A total of 8 vertebrae were removed with an average of 5 ± 2 levels of decompression and 9 ± 2 segments instrumented. The mean correction rates of TLKs and the main curves were 73 ± 15% and 87 ± 6%, respectively. Five patients (71%) had preoperative neurological symptoms with a mean Japanese Orthopedic Association (JOA) score of 8 ± 3 points. Their neurological functions were all improved, with a recovery rate of 78 ± 32% for the JOA score at the last follow-up. Four patients (57%) suffered from surgical complications, including rod breakages (43%), neurological complications (28%), dural tears (14%), cerebrospinal fluid leaks (14%) and proximal junction kyphosis (14%).

CONCLUSIONS

pVCR can offer a good correction for TLK and improve neurological function with extensive laminectomies in ACH patients. But the morbidity of surgical complications is relatively high. Therefore, it is a reserved surgical option for severe TLK in ACH patients by experienced spinal surgeons, especially with apical markedly hypoplastic vertebrae.