Vertebral Column Resection
What is a Vertebral Column Resection?
A Vertebral Column Resection (VCR) is a type of osteotomy that is used to correct severe cases of spinal deformity. Osteotomy simply means that your doctor will remove bone. However, a VCR takes this one step further.
During a VCR, your doctor will remove or “resect” one or more vertebrae from your spine. A fancier phrase for your spine is “vertebral column.” This refers to the fact that the vertebrae in your spine are stacked like a pillar. Hence, the term: Vertebral Column Resection.
Milder forms of osteotomy do not remove entire vertebrae. These include the Posterior Column Osteotomy (PCO) and the Pedicle Subtraction Osteotomy (PSO). Instead, these procedures resect tiny sections of bone on the back side of your spine.
However, if you have >100 degrees of curvature, then removing small sections of bone just won’t cut it. You’ll need a VCR to fix your spinal alignment.
But first, let’s revisit a “healthy” spine. A healthy spine isn’t ramrod straight. Instead, it contains gentle inward arcs (known as lordosis) and subtle forward curves (known as kyphosis). If too much kyphosis occurs, the shoulders round and the head pitches forward. You may hear of this referred to as a sagittal imbalance because the head is no longer balanced over the pelvis.
When viewed from the front, however, the spine should seem straight. If the spine juts outward to the side, scoliosis (a form of coronal imbalance) occurs.
Severe scoliosis or kyphosis (>100 degrees) can cause pain, lung and heart problems, issues with walking, and loss of confidence. A VCR can permanently reverse these symptoms.
How is a Vertebral Column Resection Performed?
If you need a VCR, your surgeon will position you face-down on a Jackson frame. This operating table contains a gentle slope that exposes the back side of your spine.
Depending on your situation, your doctor will enter your back from a posterior (back) or anterior (front) approach. Sometimes, a surgeon can achieve best results by using a combined, or anterior and posterior, approach. However, entry from the back is the most common.
Next, your surgeon will fasten pedicle screws to your vertebrae. These will attach to the vertebrae above and below the resection area. Then, your surgeon will remove the back portion of the targeted vertebrae. This will include your:
- Spinous Process: The three bony points on the back side of your vertebrae
- Lamina: The bony shell that guards your spinal cord
- Facet Joints: The joint where two vertebrae come together
- Pedicles: The swatch of bone that joins the vertebral body to the processes
With these items removed, your surgeon can now see your spinal cord and the round front half of your vertebra, known as the vertebral body. After removing the left side of the vertebral body, your surgeon will add rods to each screw. This crucial step in the surgical procedure protects your fragile spinal cord, which is now exposed.
Finally, the problematic vertebra can be excised. If more than one resection is needed, your surgeon will repeat the steps above. In addition, your surgeon may remove ribs, if your thoracic spine is the target of the procedure. With all vertebrae removed, a wedge-shaped gap will remain in the back side of the spine. Your doctor will then realign the spine and close this gap. Closing this hinge folds the spine backward onto itself and into a more ideal shape.
Will I Need Spinal Fusion with a Vertebral Column Resection?
Yes. Your surgeon will use a combination of implants and bone grafts to support your spine as it heals.
Specifically, graft material can be sourced from your hip or a donor supply. If needed, your surgeon may even opt to use a cage–a metal device filled with bone graft material. As the bone tissue matures, it will grow through the “bars” of the cage to fuse to your spine.
In addition, your doctor will add extra rods to brace your spine.
The ultimate goal of these last steps is to create a spine that is stable, durable, and pain-free. With the final pieces of hardware in place, the osteotomy procedure is now complete.
What are the Advantages of a Vertebral Column Resection?
Although invasive, a VCR offers many rewards to the patient. These gains include:
- Better Surgical Outcomes: When it comes to spinal deformity correction, a VCR can provide up to 80 degrees of adjustment. At best, the PCO delivers 20 degrees of relief and the PSO achieves only 30 degrees of fix.
- A Better Quality of Life: Severe spinal deformities can cause significant pain, difficulty performing day-to-day tasks, and life-threatening complications like breathing problems. A VCR can reverse these symptoms and restore your quality of life.
- Better Stability: Bone grafts, implants, and screws will keep your spine steady in the days that follow your surgery. Sturdy fusion materials also mean longer lasting results.
- Close Monitoring: In addition, your surgeon will record the electrical activity of your spinal cord throughout the procedure. This careful scrutiny ensures that you will not sustain any trauma or nerve compression while your spinal cord is exposed.
Do you need a VCR to repair your spinal curvature? Dr. Lowenstein, America’s scoliosis expert, specializes in correction surgery for complex cases of spinal deformity!
Do I Qualify for a Vertebral Column Resection?
You may need a VCR if you have:
- Severe Scoliosis: If the severity of your scoliosis is >100 degrees. This can apply to either adult or pediatric patients.
- Severe Kyphosis: If you have rigid kyphosis (>100 degrees of curvature or <10 of spinal flexibility)
- Multiple Deformities: If you have both scoliosis and kyphosis, also known as multiplanar deformities
- Severe Ankylosing Spondylitis: If AS has fused your spine into a single, rigid column
- Spinal Tumors: If you have a malignant cancer growing in or on your vertebral column
- Spondyloptosis: If your vertebra has slipped entirely off of your vertebral column (also known as Grade 5 Spondylolisthesis)
However, a VCR is not right for everyone. If you have a milder form of spinal deformity, your doctor may recommend another osteotomy technique, like the PCO or PSO, instead. To find out if you qualify for a VCR, contact Dr. Lowenstein today. Dr. Lowenstein is a master of scoliosis correction techniques. He will ensure that you get the right treatment, at the right time, and with the best results. To restore your quality of life, contact Dr. Jason Lowenstein today!