gms | German Medical Science

Objectives: The main aim of post-injury spine deformity surgery in patients with total injury of spinal cord and its radices is the restoration of support ability of spinal column. Minimally traumatic surgery which adequately corrects deformity, provides stable fixation and at the same time does not induce additional trauma to the weakened patient is considered to be the option of choice in this cohort of patients.

The aim of our study is to estimate the outcomes of vertebral column resection (VCR) in patients with rigid deformities in thoracic and lumbar spine on the background of severe SCI.

Methods: We analyzed surgical outcomes of 25 patients with rigid spine deformities after severe SCI in thoracic and lumbar spine. During clinical examination neurological status (ASIA/IMSOP scale), pain intensity (VAS scale) and rehabilitation status (FIM scale) were considered. Deformity was visualized by X-ray, CT and MRI. AO/ASIF standard was applied to classify patients according to the injury character. ENMG and TMS were investigative methods of conductive and reflectory function of spinal cord.

Surgical treatment included VCR on the top of deformity followed by correction with multi-segmental screw system with normal sagittal profile modeling. In case of special indication monosegmental resection or several vertebrae elimination was performed. At the final stage we carried out ventral supportive posterior-lateral fusion with restoration of resected segment height and if necessary detruncate vertebrotomy.

Results and conclusion: Surgical outcomes were estimated clinically and by X-ray right after the operation, 3, 6 and 12 months postsurgically. In all cases we managed to obtain full correction of deformity and stable spine fixation (Figure 1). There was no correction loss in any of the patients 12 months postsurgically. 21 patients (84.0%) noticed full regression of pain syndrome and 4 patients (16.0%) reported its decrease up to 1-2 points by VAS scale. Nevertheless all patients did not report any positive neurological changes which was consistent with electrophysiological data. However the assessment of functional independence by FIM indicated high potential for rehabilitation in patients with surgery by isolated dorsal approach.

In presence of gross rigid spine deformities with anatomic SCI and dubious forecast for its functional restoration surgeons should opt for minimally invasive reconstructions. Alongside with that surgical option should provide adequate correction of deformity and stable fixation of spinal column. Upon our knowledge and consideration of all factors mentioned above the most preferable option is dorsal VCR.