Complications of posterior vertebral column resection in spinal deformity: A systematic review
Hanmo Fang, Min Cui, Kangcheng Zhao, Yukun Zhang, Xianlin Zeng, Cao Yang, Lin XieBackground:
Posterior vertebral column resection (pVCR) is widely used to correct severe spinal deformities. However, it is a complex surgery, and the complications associated with different indications remain unclear.
Methods:
A systematic literature search was conducted in PubMed, MEDLINE, Scopus, EMBASE, and the Cochrane Library. Studies reporting clinical outcomes and complications of pVCR were included and descriptively analyzed according to underlying deformity etiology. The quality of evidence was assessed using the grading ofr ecommendationsa ssessment,d evelopment and evaluation framework.
Results:
A total of 26 studies were included. Across different indications, pVCR demonstrated substantial deformity correction, with reported kyphosis correction rates generally ranging from approximately 44% to 95%. However, complication rates varied considerably by etiology. In posttraumatic kyphosis, overall complication rates ranged from 12% to 59%, with internal fixation-related complications being relatively common. In congenital spinal deformities, the overall complication rate appeared higher (17%–100%), with neurological complications reported in approximately 7% to 9% of cases and notable rates of revision surgery and instrumentation failure. In posttuberculous kyphosis, neurological complication rates of around 15% were reported, including severe deficits in a subset of patients. In severe, rigid deformities, nonneurological complications were frequently observed, with reported rates up to 23%, along with rare mortality events. These findings suggest that the type and frequency of complications may differ across indications.
Conclusions:
pVCR may provide effective deformity correction in patients with severe spinal deformities; however, it is associated with a substantial and variable complication burden. The available evidence suggests that complication profiles differ by underlying etiology, with potentially higher risks in certain subgroups, such as congenital. Further high-quality, comparative research is required to better define the safety and indications of pVCR.