Neural Arch Preservation-Posterior Vertebral Column Resection: 2-Dimensional Operative Video

Abstract

This technique is a modification of the posterior vertebral column resection (PVCR) for patients with kyphoscoliosis with vertebral column resection indications (Cobb angle >100° angular and rigid with flexibility <20%-30%). The neural arch (preservation)-PVCR has the biomechanical advantage of maintaining the dural sac and the spinal cord attached within the neural arch and ligamentum flavum (dorsal meningovertebral ligaments are in tension in kyphosis), avoiding spinal cord deviation during the vertebrectomy. Preserving the neural arch did not interfere with corrective maneuvers of the anterior and middle columns and avoided the spinal translation in any anatomic plane. Standard posterior spinal midline approach and insertion of pedicle screws, a temporary rod is placed on contralateral side to maintain the stability of the spine during neural arch (preservation)-PVCR and to prevent translation of the spine. A costotransversectomy for an anterior approach is performed in the apex level and discectomies of the upper and lower levels. The anterior column reconstruction is made with a structural graft or titanium mesh cage with autograft. The correction is made with compression of the segment of the osteotomy, kyphosis correction with "in situ" rod benders, and Cantilever maneuver for final correction. A multiple rod construction is placed to increase stability. This technique has the potential benefits of decreasing operative time and blood loss, protecting the neural elements from fibrous scars and more posterior fusion for decreasing pseudoarthrosis. The patient consented to the procedure. The participants and any identifiable individuals consented to publication of his/her image.