Vertebral Column Resection (VCR) in Pediatric Spinal Deformity
What is a Vertebral Column Resection (VCR)?
A VCR is complete surgical removal of one, or more, vertebra. It is always combined with posterior spinal fusion and instrumentation. This means screws, rods, and possibly cages are used to hold the spine in the new alignment while the spine undergoes bony fusion. Example C below.
A VCR is also called a Three-Column Osteotomy or a Corpectomy.
When is a VCR needed?
A VCR may be needed when a severe, rigid spinal deformity is to be corrected. It can be used to treat hyperkyphosis (abnormal forward curvature of the spine) or scoliosis (abnormal side curvature of the spine).
Why would more than 1 vertebra be removed?
Removal of a single vertebra can permit 80+ degrees of correction. Despite this fact a 2nd vertebra may also need to be removed to achieve the desired correction safely.
What happens to the gap between the vertebra after a VCR?
After a VCR the two ends of the spine can be moved in space to correct the spine deformity. Ideally there is no gap, and the vertebra can be moved so that there is bone-on-bone contact. However, at times there is a gap after the spine deformity is corrected. The presence of a gap or hole is dependent upon the type and severity of the spinal deformity. If there is a gap a “cage” is placed which struts from the upper vertebra to the lower vertebra.
Why is a “cage” sometimes placed?
A “cage” strengthens the surgery, by providing a strut from vertebra to vertebra on the front side of the spinal cord. The usual spinal instrumentation is placed in the back of the spinal cord. So a “cage” gives 2 areas of stabilization for the spine. This can increase the likelihood the instrumentation holding the spine and a successful fusion of the surgery.
Below is a 10 year old female with Neurofibromatosis Type 1 and a progressive kyphosis. On the left x-ray the vertebra with the red arrow pointing to it was removed. On the right, the blue arrow points to the “cage” which was placed at the defect site, to support the spinal column in front of the spinal cord.
Next week we will go over how we do this surgery.