The safety and efficacy of posterior vertebral column resection in treating severe thoracolumbar Pott's deformity: a multicenter study with long-term follow-up.

Abstract

Objective: In this multicenter study, the authors conducted a comprehensive analysis of the safety and efficacy of posterior vertebral column resection (PVCR) for the treatment of thoracolumbar Pott's kyphosis.

Methods: The records of patients with severe thoracolumbar kyphosis (local kyphosis [LK] ≥ 90°) who underwent PVCR across 7 centers from September 2013 to August 2018 were retrospectively analyzed. The operation-related data were collected. Comparisons of spinopelvic parameters as well as American Spinal Injury Association Impairment Scale (AIS) grades were made preoperatively, postoperatively, and at the final follow-up.

Results: A total of 145 patients were included in this study, with an average follow-up of 105.7 months. LK decreased from 107.3° before surgery to 32.0° after surgery (p < 0.05) and slightly reverted to 37.1° at the final follow-up (p < 0.05). Thoracic kyphosis and lumbar lordosis significantly improved from 6.0° ± 6.9° and 75.8° ± 12.9° preoperatively to -12.7° ± 7.3° and 44.0° ± 9.5° postoperatively, respectively (both p < 0.05). The preoperative neurological function of 94 patients was AIS grade E, and 114 and 121 patients reached AIS grade E by 3 months postoperatively and the final follow-up, respectively. The Scoliosis Research Society-22 questionnaire score of patients at the final follow-up was significantly improved after surgery, increasing from 2.9 ± 0.3 points before surgery to 3.9 ± 0.2 points at the final follow-up (p < 0.05). Twenty-nine patients experienced early complications. Late complications occurred in 24 patients, including instrument failure in 17 cases, adjacent segment failure in 3 cases, and nonunion in 4 cases.

Conclusions: PVCR is an effective surgical intervention for severe thoracolumbar kyphosis, with patients achieving significantly improved spinal alignment, neurological function, and quality of life in the long term. Care should be taken to prevent complications related to surgery and implant failure.