Vertebral column resection for rigid spinal deformity

Study Design: Broad narrative review. Objective: To review the evolution, operative technique, outcomes, and complications associated with posterior vertebral column resection. Methods: A literature review of posterior vertebral column resection was performed. The authors’ surgical technique is outlined in detail. The authors’ experience and the literature regarding vertebral column resection are discussed at length. Results: Treatment of severe, rigid coronal and/or sagittal malalignment with posterior vertebral column resection results in approximately 50–70% correction depending on the type of deformity. Surgical site infection rates range from 2.9% to 9.7%. Transient and permanent neurologic injury rates range from 0% to 13.8% and 0% to 6.3%, respectively. Although there are significant variations in EBL throughout the literature, it can be minimized by utilizing tranexamic acid intraoperatively. Conclusion: The ability to correct a rigid deformity in the spine relies on osteotomies. Each osteotomy is associated with a particular magnitude of correction at a single level. Posterior vertebral column resection is the most powerful posterior osteotomy method providing a successful correction of fixed complex deformities. Despite meticulous surgical technique and precision, this robust osteotomy technique can be associated with significant morbidity even in the most experienced hands.