Objective
The posterior vertebral column resection (PVCR) comprises a one-step resection of the vertebral body by a costotransversectomy together with a 360° spondylodesis. After removing the vertebral body, straightening of the existing kyphotic malposition is possible.
Indications
Pronounced thoracic kyphosis after osteoporotic sintering fractures in one or more vertebral bodies.
Contraindications
General contraindications for surgical procedures, ASA >3 (American Society of Anesthesiologists).
Surgical technique
First, dorsal stabilization of the vertebral column on at least two levels cranial and caudal of the VCR. Next, in a one-step procedure the laminectomy with costotransversectomy and the resection of the vertebral body is done. The ventral defect gap is filled by a mesh cage to provide ventral support. By compression the malposition is reduced and the mesh cage is fixed into position. Finally the vertebrae joints are opened up using a chisel and bone or bone substitute is placed to complete the 360° spondylodesis.
Postoperative management
Functional treatment without peak load exercises as well as appropriate osteoporosis treatment.
Results
In a retrospective study 10 patients treated with this surgical technique were investigated. The results show a very good correction of the kyphotic maldeformity while the complications remain moderate.