Perioperative Major Non-neurological Complications in 105 Patients Undergoing Posterior Vertebral Column Resection Procedures for Severe Rigid Deformities

Study Design. Retrospective study. Objective. To analyze the perioperative major non-neurological complications (MNNCs) in posterior vertebral column resection (PVCR) procedures for severe rigid deformities and to identify the factors that may increase the risk. Summary of Background Data. Although surgeons constantly attempted to increase the corrective efficacy and neurological safety after PVCR, there are still significant risks of major and potentially life-threatening complications. Methods. A total of 105 consecutive patients with severe rigid deformity who underwent 1-stage PVCR at a single center from 2004 to 2013 were reviewed. The demographic data, medical and surgical histories, perioperative and final follow-up radiographical measurements, and prevalence of perioperative MNNCs were reviewed. Results. The mean age of patients at the time of surgery was 18.9 years (range: 10-45 yr). The major curve of scoliosis was 108.9 +/- 25.5 preoperatively and 37.2 +/- 16.8 at the final follow-up, and segmental kyphosis was from 89.8 +/- 31.1 to 30.4 +/- 15.3. There were 31 MNNCs in 24 patients: 16 respiratory complications in 13 patients, 9 cardiovascular adverse events in 7 cases, 1 malignant hyperthermia, and 1 optic deficit. There were 3 patients with wound infection, and 1 of them had to undergo partial removal of the implant for infection control. One patient with neurofibromatosis died 1 day after operation. Factors that showed no relationships with an increased prevalence of MNNCs were age, sex, presence of cardiac disease or neural axis malformation, and both sagittal and coronal correction rate. Patients with T6 and upper resected level, undergoing PVCR at the early period, showed a trend toward more MNNCs encountered. Moreover, nonidiopathic deformity, large scoliotic curve greater than 150 degrees, percent predicated forced vital capacity and forced expiratory volume in 1 second (FEV 1.0) less than 40%, and estimated blood loss volume more than 5000 mL were identified as risk factors associated with MNNCs. Conclusion. Patients who had undergone PVCR experienced expected higher rate of MNNCs, with an overall prevalence of 22.9%. When considering PVCR, it is important to recognize the significantly higher inherent risks and provide appropriate preoperative counseling on the risks and benefits of surgery.