Vertebral Column Resection (VCR) in Pediatric Spinal Deformity
How is a Vertebral Column Resection Performed?
After the incision, spinal exposure and placement of pedicle screws the next important step is to place a rod across the VCR site (see below at green arrow). This is important as a VCR significantly destabilizes the spine, and not having 1 or 2 rods across the VCR the spine can move, or subluxate, which can cause the spinal cord to not function normal.
Next, the VCR step is to carefully remove the vertebra of interest, piece by piece, working from the back of the vertebra to front. The back, or roof, of the spinal column if first take off, to expose the spinal cord (see blue arrow in the surgical photo and the red arrow in the drawing).
The 2 ribs connected to the vertebra of interest are identified and exposed the medial 4-5 cm of the ribs are removed.
After the lamina is resected, retractors are placed around the vertebral body to safely expose the bone and protect the vital structures on the sides and in front of the spine (see below, red and black lines).
See the operative picture below for the retractor (green arrow)
Next the pedicles (see red arrows in below diagram), the column of bone which connects the back or roof of the spinal column to the vertebral body are resected. This would leave only the vertebral body (#1).
Now the spinal cord can be seen on the back, left and right side. The bone of the vertebral body is the carefully removed (below) with curettes and drills.
After removal of the body…the discs on each side of the VCR are then removed (see below).
Once the vertebral body is completely removed, the spinal cord is a tube which bridges from one vertebral to the adjacent vertebra (green arrow below).
It is now time to take the deformed spine and realign it to a better position, which is done by bending the rod and compressing the spine above and below the VCR defect site together (see below)
Sometimes the space can be completely closed down, bone on bone. Other times a small “cage” is needed to bridge the gap. This is important from a spinal stability and healing of the bone fusion. A gap in the front can allow too much movement of the spine and prevent the fusion from healing, causing the rods to break or screws to move or pull out of the bone.
A cage was used in the surgical case shown below (red arrows)
Once good spinal alignment is achieved, the spinal column is stabilized with 2 or more rods, in its new and improved position.
All the implants (pedicle screws, hooks, cages and rods) help to attain the new spine alignment, but also maintain it until the spine fusions set up and is durable. The development of a spine fusion can take several years to get hard and durable.