Complications of Posterior Vertebral Resection for Spinal Deformity

Study Design: Retrospective study. Purpose: To evaluate the incidence and risk factors of complications following posterior vertebral resection (PVR) for spinal deformity. Methods: A review of 233 patients treated with PVR at one institution over a nine-year period (1997 to 2005) was performed. The average age was 33.5 years. Complications were assessed in terms of surgical techniques (posterior vertebral column resection [PVCR] and decancellation osteotomy) and etiologies of deformity. Results: Local kyphosis was corrected from 51.4 degrees to 2.7 degrees, thoracic scoliosis 63.9 degrees to 24.5 degrees (62.6% correction), and thoracolumbar or lumbar scoliosis 50.1 degrees to 17.1 degrees (67.6%). The overall incidence of complications was 40.3%. There was no significant difference between PVCR and decancellation osteotomy in the incidence of complications. There were more complications in the older patients (> 35 years) than the younger (p < 0.05). Higher than 3,000 ml of blood loss and 200 minutes of operation time increased the incidence of complications, with significant difference (p < 0.05). More than 5 levels of fusion significantly increased the total number of complications and postoperative neurologic deficit (p < 0.05). Most of the postoperative paraplegia cases had preoperative neurologic deficit. Preoperative kyphosis, especially in tuberculous sequela, had higher incidences of complications and postoperative neurologic deficit (p < 0.05). More than 40 degrees of kyphosis correction had the tendency to increase complications and postoperative neurologic deficit without statistical significance (p > 0.05). There was 1 mortality case by heart failure. Revision surgery was performed in 15 patients for metal failure or progressing curve. Conclusions: The overall incidence of complications of PVR was 40.3%. Older age, abundant blood loss, preoperative kyphosis, and long fusion were risk factors for complications.