Posterior 2-Level Vertebral Column Resection for the Treatment of Progressive Rotational Dislocation in Kyphoscoliotic Deformities.

Abstract

Progressive rotational dislocation of the spine is rare and surgical treatment is challenging. Few reports have described surgical decompression, fusion, and partial correction by traditional 2-stage anterior decompression and the posterior fixation technique. The goal of this retrospective study was to report a series of 6 patients with this deformity and the outcome after treatment by posterior-only 2-level vertebral column resection (PVCR). Between 2011 and 2014, 6 patients were treated for kyphoscoliotic deformities with progressive rotational dislocation. In these 6 patients (2 males and 4 females), the diagnosis included 4 cases of congenital kyphosis and 2 cases of neurofibromatosis; the distribution of spine level was from T4 to T11; the kyphosis angle of the patients was 115° (range, 107-125°); the scoliosis angle was 97° (range, 80°-117°); follow-up ranged from 13 to 51 months (mean, 27 months). Four patients developed progressive onset of neurologic deficit. All patients underwent surgery by 2-level PVCR for decompression and correction of kyphoscoliosis. Postoperatively, the patients all had different kyphosis correction rates, from 49% to 72% (mean, 63%) and scoliosis correction rates, from 57% to 78% (mean, 65%). All patients achieved successful spinal fusion with less than 3° of loss of correction at the latest follow-up evaluation. The 4 patients with incomplete neurologic deficits improved 1 or 2 American Spinal Injury Association scales at follow-up of at least 6 months. Two-level PVCR is a safe and efficacious surgical option for the treatment of rotational dislocation in kyphoscoliosis and associated neurologic deficit.