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Column decancellation may be a viable option for spinal deformity

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Researchers have introduced a new concept, called single-stage posterior vertebral column decancellation, which appears to be an effective alternative to manage sharp angular spinal deformities.

The goal of managing sharp angular spinal deformity is to re-align the spinal deformity and safely decompress the body’s neurological components. However, study researcher Yan Wang, MD, PhD, noted that this can present some challenges to current osteotomy treatment.

Vertebral column decancellation is multilevel vertebral body decancellation that encompasses removal of the residual disc, extensive posterior decompression, gentle manipulation, osteoclasis anterior apex, hinge retroposition, anterior open elongation and bony cage metal mesh, according to Wang, an orthopedist at the Chinese PLA General Hospital in Beijing, China.

Some limitations of the current treatments, such as vertebral column resection, that Wang discussed were greater risk of neurological deficit (sagittal translation or bulking), lack of stability, more manipulation performed in chord territory, more blood loss, subsidence and misplace of metal mesh.

“Results of our study showed less risk of neurological deficit, stability with less vascular complications and less blood loss, among other benefits,” he said.

Wang presented the results of this retrospective review at the 12th EFORT Congress 2011 held in Copenhagen, Denmark.

From January 2004 to March 2007, the researchers evaluated 45 patients with severe sharp angular spinal deformities who underwent vertebral column decancellation. Wang and colleagues conducted preoperative and postoperative radiographic evaluations.

Of these patients, 29 had congenital kyphoscoliosis and 16 had Pott’s deformity.

Results showed that for a kyphosis type deformity, an average of 2.2 vertebrae were decancellated. The mean preoperative kyphosis was 98.6°. The mean kyphosis in the immediate postoperative period was 16.4° with an average postoperative correction of 82.2°. For a kyphoscoliosis type deformity, the correction rate postoperatively was 64% in the coronal plane and 32.5° at 2-years follow-up.

Complications occurred in eight patients. They included four cases of a transient neurological deficit, one complete paralysis, one cerebrospinal fluid leak, an epidural hematoma and one case of deep infection, according to Wang. In addition, neurological complications occurred in five of the patients. – by Tara Grassia

Reference:

• Wang Y, Xiao S, Zhang Y, et al. Vertebral column decancellation for the management of sharp angular spinal deformity. Presented at the 12th EFORT Congress 2011. June 1-4. Copenhagen, Denmark.

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