Thoracic Scoliosis: Vertebral Resection

Vertebral Resection

Kirkham B. Wood

Goal of Surgical Treatment

The goal is to reestablish spinal balance in the sagittal, coronal, and axial planes. Because the risk of neurologic injury is so strong when attempting to correct fixed, rigid, severe, spinal deformities, the resection of one or more apical vertebral bodies allows for the “shortening” of the spinal column and less risk of neurologic trauma.

Diagnosis

Thoracic scoliosis is a three-dimensional rotational deformity of the spine whose apex lies between T2 and T12. This chapter deals with a select subset of thoracic scoliosis: the spine that cannot be brought into balance through either the traditional posterior approach or a combined anterior/ posterior operation with or without osteotomies. This diagnosis is made by history (e.g., multiple previous failed operations, untreated congenital deformity), and plain radiographs including bending films to assess flexibility as well as compensation. The spine is further stiffened by the ribs, thorax, and sternum.

Indications for Surgery

A fixed and rigid thoracic scoliosis in which, based on the physical examination, history, and radiology including bending x-rays, it is felt that even a combined anterior/posterior approach stands a high chance of failing to adequately balance the spine.

1. Significant cosmetic deformity

2. > 6-cm coronal plane imbalance that cannot be centered on side bending

3. Fixed upper thoracic and pelvic obliquity

4. Fixed asymmetric length between the concave and convex sides of the spine

5. Severe rigid thoracic scoliosis that threatens to worsen

Contraindications for Surgery

1. A flexible thoracolumbar spine that corrects on side-bending into a more physiologic range

2. Previous anterior thoracic exposure (relative)

3. Active spinal infection

Advantages

1. Ability to balance (in three planes) a rigidly fixed thoracic scoliosis deformity typically resistant to correction from either a posterior alone or a posterior/anterior approach.

2. Improved cosmesis.

3. Shortening the spine (versus lengthening the spine as in a closing wedge osteotomy posteriorly) lessens the risk of neurologic injury.

4. Thoracoplasty can be combined for those with residual axial plane deformity and to increase flexibility, and it provides abundant auto-genous bone graft.