Vertebral column decancellation for the management of sharp angular spinal deformity

The management goal of sharp angular spinal deformity is to realign the spinal deformity and safely decompress the neurological elements. However, some shortcomings related to current osteotomy treatment for these deformities are still evident. We have developed a new spinal osteotomy technique—vertebral column decancellation (VCD), including multilevel vertebral decancellation, removal of residual disc, osteoclasis of the concave cortex, compression of the convex cortex accompanied by posterior instrumentation with pedicle screws, with the expectation to decrease surgical-related complications. From January 2004 to March 2007, 45 patients (27 males/18 females) with severe sharp angular spinal deformities at our institution underwent VCD. The diagnoses included 29 congenital kyphoscoliosis and 16 Pott’s deformity. Preoperative and postoperative radiographic evaluation was performed. Intraoperative, postoperative and general complications were noted. For a kyphosis deformity, an average of 2.2 vertebrae was decancellated (range, 2–4 vertebrae). The mean preoperative kyphosis was +98.6° (range, 82°–138°), and the mean kyphosis in the immediate postoperative period was +16.4° (range, 4°–30°) with an average postoperative correction of +82.2° (range, 61°–124°). For a kyphoscoliosis deformity, the correction rate was 64% in the coronal plane (from 83.4°–30.0°) postoperatively and 32.5° (61% correction) at 2 years’ follow-up. In the sagittal plane, the average preoperative curve of 88.5° was corrected to 28.6° immediately after surgery and to 31.0° at 2 years’ follow-up. All patients had solid fusion at latest follow-up. Complications were encountered in eight patients (17.8%), including CSF leak (n = 1), deep wound infection (n = 1), epidural hematoma (n = 1), transient neurological deficit (n = 4), and complete paralysis (n = 1). The results of this study show that single-stage posterior VCD is an effective option to manage severe sharp angular spinal deformities.