Posterior vertebral column resection with preservation of posterior ligamentous complex for severe angular spinal kyphotic deformity: a comparative study.

Background: Angular spinal kyphotic deformity could result in significant cardiopulmonary dysfunction, poor self-image, and neurological deficits. Posterior vertebral column resection (PVCR) is a highly effective technique for correcting spinal malignment. However, the limitations such as instability from radical removal of posterior elements associated with a high rate of neurological complications. The purpose of this study was to compare the effectiveness and safety of modified PVCR and traditional PVCR in the treatment of patients with angular spinal kyphotic deformity.

Methods: A retrospective cohort study was conducted. Patients who underwent PVCR for angular spinal kyphotic deformity with a minimum of 24 months follow-up from March 2018 to November 2022 were included. These patients had a focal kyphosis (FK) with deformity angular ratio greater than 20. Patients were divided into the modified PVCR group and the traditional PVCR group based on the procedures. The modified PVCR, which preserved the posterior ligamentous complex (PLC) throughout the process, was performed for patients who were admitted to the hospital after October 2020. Demographic information, radiological parameters, surgical information, health-related quality of life, and complications were collected and compared between the groups.

Results: A total of 62 patients with angular spinal kyphotic deformity were recruited in this study. The mean age at surgery was 42.29 ± 12.42 years. Among the patients, 31 were in the modified PVCR group and 31 were in the traditional PVCR group. The FK was corrected from 125.54° ± 15.83° to 48.19° ± 16.07° in the modified PVCR group and 119.77° ± 17.10° to 57.20° ± 15.43° in the traditional PVCR group. The correction rate of FK in the modified PVCR group was significantly greater than the traditional PVCR group (62.26% ± 10.24% vs. 51.46% ± 15.49%, P = 0.002). There were no significant differences in the operation time, estimated blood loss, and health-related quality of life between the two groups. However, the incidence of neurological complications was 16.1% in the modified PVCR group, significantly lower Than the 38.7% observed in the traditional PVCR group (P = 0.046).

Conclusions: By preserving the PLC throughout the osteotomy, the modified PVCR outperformed the traditional technique in terms of both neurological complications and deformity correction.