Severe twisting or bending of the spine
can cause serious medical problems,
especially as patients age. For some
patients seen at the Washington University and Barnes-Jewish Spine Care Center, a surgical procedure called
vertebral column resection (VCR) may
be the answer.
The most common mid-spine deformities include scoliosis, kyphosis, and kyphoscoliosis, a condition that
combines both the hump of kyphosis
and the twisted corkscrew shape of
scoliosis. These conditions put pressure
on the ribcage, eventually making it
difficult to breathe.
How VCR works
When the deformity becomes severe, the spine is rigid and hard to manipulate. During the VCR procedure, surgeons take the vertebra that is the farthest out of alignment and remove it completely, creating a temporary spinal instability and flexibility. Then they can carefully reconnect, or fuse, the spinal column to straighten it out. To prevent neurologic complications, surgeons continuously monitor the spinal cord’s function during the surgery.
VCR for cervical deformities
Neill Wright, MD, a Washington
University neurological surgeon at
Barnes-Jewish Hospital, uses VCR to
treat patients with severe cervical spine
deformities. The results can be just as
dramatic as those for back curvature.
“We find that, in addition to trauma, we
have two main situations in the cervical
spine for which VCR is appropriate,”
says Wright. The first, ankylosing
spondylitis, is a chronic inflammatory
autoimmune disease that causes fusing
of the vertebrae. When vertebrae fuse in
alignment, patients’ symptoms can be
managed without surgery, but in some
cases, the neck fuses in a dramatic way.
“One 34-year old man with this
condition had an undiagnosed neck
fracture that caused his cervical spine
to fuse so that his chin rested rigidly
on his chest in a fixed looking-down
position. VCR was done to remove the
broken vertebra and straighten his neck,
restoring function,” Wright says.
The other common application,
usually seen in older adults, is severe
degenerative arthritis, in which the
vertebrae degenerate and cause the spine
to buckle under the weight of the head.
In this condition, the head drops forward
but is moveable. “For these patients, we
remove bone and shore up the vertebrae
to support the head,” Wright says.
The future of VCR
Ian Dorward, MD, a Washington University neurosurgeon and orthopedic surgeon at Barnes-Jewish Hospital, completed a fellowship in spinal surgery. “What makes us truly unique is refining this expertise through the collaboration of orthopedics and neurosurgery,” Dorward says.