Peri-operative major non-neurologic complications in posterior vertebral column resection

English Keywords:Severe and rigid spinal deformity  Posterior vertebral column resection  Complication

English Abstract:

  【Abstract】 Objectives: To analyze the peri-operative major non-neurologic complications(MNNCs) in posterior vertebral column resection(PVCR) procedures, and to identify the factors that may increase the risk. Methods: A total of 105 consecutive patients with severe rigid deformity who underwent one-stage PVCR at a single center from 2004 to 2013 were reviewed. The demographic data, medical and surgical histories, perioperative and final follow-up radiographic measurements, prevalence of perioperative MNNCs were reviewed. Results: The mean age of patients at the time of surgery was 18.9±8.1(10-45) years. 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°. Vertebral resection involved an average of 1.31 levels, and fusion extended an average of 13.6±2.8 levels. The coronal balance correction rate was 70.9%, and sagittal balance correction rate was 53.4%。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 cases with wound infection, and 1 of them had to be partly removed the implant for infection control. One patient with neurofibromatosis died at one day after operation. Patients with T6 and upper resected level, undergoing PVCR at the early period, showed a trend toward more MNNCs encountered. Moreover, non-idiopathic deformity, large scoliotic curve >150°, percent predicated FVC and FEV1.0 <40%, and EBL>5000ml were identified as risk factors associated with MNNC. Conclusions: Patients who undergo posterior vertebral column resection(PVCR) experience expect highly rate of major non-neurologic complications, and it is associated with poor pulmonary function and the amount of blood loss during operation.