成人脊柱変形に対するVertebral Column Resection（VCR）の成績と合併症について

はじめに：近年，成人脊柱変形や高度脊柱変形の手術は目覚ましい発展があるが，そのなかで最も難度の高い手術がVertebral Column Resection（VCR）に代表されるThree Column Osteotomyである．今回は成人脊柱変形に対するVCRの成績と合併症について検討した．対象：成人脊柱変形に対してVCRを行った症例は14例で，疾患は脊柱側弯症術後悪化例（Revision Surgery）が7例，思春期側弯症遺残が4例，成人後側弯症2例，先天性後弯症が1例であった．全例で腰背部痛を伴っており1例は脊髄完全麻痺，2例は下肢痙性を認めた．術前側弯度は平均71.8度で，矢状面バラ...

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Published inJournal of Spine Research Vol. 16; no. 6; pp. 919 - 926
Main Authors 鳥飼, 英久, 中田, 好則, 井上, 雅俊
Format Journal Article
LanguageJapanese
Published 一般社団法人 日本脊椎脊髄病学会 20.06.2025
Subjects
側弯症再手術
成人脊柱変形
椎体骨切り術
Online AccessGet full text
ISSN1884-7137
2435-1563
DOI10.34371/jspineres.2025-3026

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Abstract はじめに：近年，成人脊柱変形や高度脊柱変形の手術は目覚ましい発展があるが，そのなかで最も難度の高い手術がVertebral Column Resection（VCR）に代表されるThree Column Osteotomyである．今回は成人脊柱変形に対するVCRの成績と合併症について検討した．対象：成人脊柱変形に対してVCRを行った症例は14例で，疾患は脊柱側弯症術後悪化例（Revision Surgery）が7例，思春期側弯症遺残が4例，成人後側弯症2例，先天性後弯症が1例であった．全例で腰背部痛を伴っており1例は脊髄完全麻痺，2例は下肢痙性を認めた．術前側弯度は平均71.8度で，矢状面バランス評価はSRS-Schwab分類でのmarked imbalanceを7例に認めた．結果：手術は14例中13例で後方から一期的なPosterior VCRを行った．VCRの高位はL1が7例，T12，L2が各2例，T8，10，11が各1例で，固定椎体数は平均9.3椎体であった．術後6ヶ月～1年での側弯度は平均30.8度，平均矯正率は57.2％で，術後矢状面バランスはmarked imbalanceが2例であった．術前自己血を平均1,800 ml貯血したが，術中出血は平均5,129 mlとなりMAP輸血を6例（42.8％）に追加した．周術期合併症は14例中5例（35.7％）に認め，内訳は一過性の神経系合併症2例，呼吸器系合併症2例，創部感染1例であった．結語：成人高度脊柱変形に対して，VCRを行い，側弯は57.2%の矯正が得られたが，35.7％に周術期合併症を認めた．特にRevision Surgeryでは矯正が困難で，固定範囲が長く，合併症頻度も多かった．出血対策として高濃度のトラネキサム酸使用は術中出血量を低下させる可能性があるが，Revision Surgeryでの2期的手術の導入など今後課題の多い手術である．
AbstractList はじめに：近年，成人脊柱変形や高度脊柱変形の手術は目覚ましい発展があるが，そのなかで最も難度の高い手術がVertebral Column Resection（VCR）に代表されるThree Column Osteotomyである．今回は成人脊柱変形に対するVCRの成績と合併症について検討した．対象：成人脊柱変形に対してVCRを行った症例は14例で，疾患は脊柱側弯症術後悪化例（Revision Surgery）が7例，思春期側弯症遺残が4例，成人後側弯症2例，先天性後弯症が1例であった．全例で腰背部痛を伴っており1例は脊髄完全麻痺，2例は下肢痙性を認めた．術前側弯度は平均71.8度で，矢状面バランス評価はSRS-Schwab分類でのmarked imbalanceを7例に認めた．結果：手術は14例中13例で後方から一期的なPosterior VCRを行った．VCRの高位はL1が7例，T12，L2が各2例，T8，10，11が各1例で，固定椎体数は平均9.3椎体であった．術後6ヶ月～1年での側弯度は平均30.8度，平均矯正率は57.2％で，術後矢状面バランスはmarked imbalanceが2例であった．術前自己血を平均1,800 ml貯血したが，術中出血は平均5,129 mlとなりMAP輸血を6例（42.8％）に追加した．周術期合併症は14例中5例（35.7％）に認め，内訳は一過性の神経系合併症2例，呼吸器系合併症2例，創部感染1例であった．結語：成人高度脊柱変形に対して，VCRを行い，側弯は57.2%の矯正が得られたが，35.7％に周術期合併症を認めた．特にRevision Surgeryでは矯正が困難で，固定範囲が長く，合併症頻度も多かった．出血対策として高濃度のトラネキサム酸使用は術中出血量を低下させる可能性があるが，Revision Surgeryでの2期的手術の導入など今後課題の多い手術である．
Author 鳥飼, 英久
井上, 雅俊
中田, 好則
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References 14) Sansur C, Coe J, Smith J, et al: Scoliosis research society mobility and mortality of adult scoliosis. Spine J. 2009; 9: 345
4) Lenke LG, Sides BA, Koester LA, et al: Vertebral column resection for the treatment of severe spinal deformity. Clin Orthop Relat Res. 2010; 468: 687-699
18) Song Z, Zhang Z, Yang X, et al: Posterior vertebral column resection for severe spinal deformity correction: comparison of pediatric, adolescent, and adult groups. Compute intell neurosci. 2022; Article ID 5730856: 1-8
10) Lenke LG, Newton PO, Sucato DJ, et al: Complications after 147 consecutive vertebral column resections for severe pediatric spinal deformity: a multicenter analysis. Spine. 2013; 38: 119-132
9) Suk SI: Vertebral column resection for complex spinal deformity: posterior approach. The text book of spinal surgery. In Bridwell KH, DeWald RL, eds.. Philadelphia PA, Lippincott-Williams &Wilkins, pp999-1014, 2011.
13) Kim SS, Cho BC, Kim JH, et al: Complications of posterior vertebral resection for spinal deformity. Asian Spine J. 2012; 6: 257-265
17) Cho SK, Lenke LG, Balon SM, et al: Can intraoperative spinal cord monitoring reliably help prevent paraplegia during posterior vertebral column resection surgery. Spine Deform. 2015; 3: 73-81
6) Hamzaoglu A, Alanay A, Ozturk C, et al: Posterior vertebral column resection in severe spinal deformities; a total of 102 cases. Spine. 2011; 36: E340-E344
11) Papadopoulos EC, Boachie-Adjei O, Hess WF, et al: Early outcomes and complications of posterior vertebral column resection. Spine J. 2015; 15: 983-991
15) Lyer S, Nemani VM, Kim HJ: A Review of Complications and Outcomes following Vertebral Column Resection in Adults. Asian Spine J. 2016; 10: 601-609
2) Suk SI, Kim JH, Kim WJ, et al: Posterior vertebral column resection for severe spinal deformities. Spine. 2002; 27: 2374-2382
3) Lenke LG, Sides BA, Bridwell KH, et al: Posterior vertebral column resection for severe pediatric deformity: minimum two-year follow-up of thirty-five consecutive patients. Spine. 2009; 34: 2213-2221
19) Lau D, Deviren V, Ames CP: The impact of surgeon experience on perioperative complications and operative measures following thoracolumbar 3-column osteotomy for adult spinal deformity: overcoming the learning curve. J Neurosurg Spine. 2019; 32: 207-220
7) Xie J, Zhang Y, Wang Zhao Z, et al: Posterior vertebral column resection of rigid spinal deformity curves greater than 100 degrees. J Neuosurg Spine. 2012; 17: 540-551
12) Zhang HQ, Li JS, Liu SH, et al: The use of posterior vertebral column resection in the management of severe posttuberculous kyphosis: a retrospective study and literature review. Acta Orthop Trauma Surg. 2013; 133: 1211-1218
5) Van Halm-Lutterodt NI, Al-Saidi NN, Mandalia K, et al: Comparison of Overall Complication Rates in VCR-Based vs Non-VCR-Based Corrective Techniques in Severe Rigid Kyphoscoliosis Patients: A Systematic Review and Meta-Analysis. Global Spine J. 2023; 13: 1646-1657
16) Xie JM, Zhang Y, Wang YS, et al: The risk factor of neurologic deficits of one-stage posterior vertebral column resection for patients with severe and rigid spinal deformities. Eur Spine J. 2014; 23: 149-156
20) Kim AH, Mo KC, Harris AB, et al: High-Dose TXA Is Associated with Less Blood Loss Than Low-Dose TXA without Increased Complications in Patients with Complex Adult Spinal Deformity. J Bone Joint Surg Am. 2024; 106: 2205-2214
1) Bradford DS: Vertebral column resection. Orthop Trans. 1987; 11: 502
8) Bianco K, Norton R, Schwab F, Smith JS, et al: Complications and intercenter variability of three-column osteotomies for spinal deformity surgery: a retrospective review of 423 patients. Neurosurg Focus. 2014; 36: E18
References_xml – reference: 16) Xie JM, Zhang Y, Wang YS, et al: The risk factor of neurologic deficits of one-stage posterior vertebral column resection for patients with severe and rigid spinal deformities. Eur Spine J. 2014; 23: 149-156
– reference: 19) Lau D, Deviren V, Ames CP: The impact of surgeon experience on perioperative complications and operative measures following thoracolumbar 3-column osteotomy for adult spinal deformity: overcoming the learning curve. J Neurosurg Spine. 2019; 32: 207-220
– reference: 3) Lenke LG, Sides BA, Bridwell KH, et al: Posterior vertebral column resection for severe pediatric deformity: minimum two-year follow-up of thirty-five consecutive patients. Spine. 2009; 34: 2213-2221
– reference: 18) Song Z, Zhang Z, Yang X, et al: Posterior vertebral column resection for severe spinal deformity correction: comparison of pediatric, adolescent, and adult groups. Compute intell neurosci. 2022; Article ID 5730856: 1-8
– reference: 13) Kim SS, Cho BC, Kim JH, et al: Complications of posterior vertebral resection for spinal deformity. Asian Spine J. 2012; 6: 257-265
– reference: 7) Xie J, Zhang Y, Wang Zhao Z, et al: Posterior vertebral column resection of rigid spinal deformity curves greater than 100 degrees. J Neuosurg Spine. 2012; 17: 540-551
– reference: 4) Lenke LG, Sides BA, Koester LA, et al: Vertebral column resection for the treatment of severe spinal deformity. Clin Orthop Relat Res. 2010; 468: 687-699
– reference: 9) Suk SI: Vertebral column resection for complex spinal deformity: posterior approach. The text book of spinal surgery. In Bridwell KH, DeWald RL, eds.. Philadelphia PA, Lippincott-Williams &Wilkins, pp999-1014, 2011.
– reference: 10) Lenke LG, Newton PO, Sucato DJ, et al: Complications after 147 consecutive vertebral column resections for severe pediatric spinal deformity: a multicenter analysis. Spine. 2013; 38: 119-132
– reference: 14) Sansur C, Coe J, Smith J, et al: Scoliosis research society mobility and mortality of adult scoliosis. Spine J. 2009; 9: 345
– reference: 5) Van Halm-Lutterodt NI, Al-Saidi NN, Mandalia K, et al: Comparison of Overall Complication Rates in VCR-Based vs Non-VCR-Based Corrective Techniques in Severe Rigid Kyphoscoliosis Patients: A Systematic Review and Meta-Analysis. Global Spine J. 2023; 13: 1646-1657
– reference: 2) Suk SI, Kim JH, Kim WJ, et al: Posterior vertebral column resection for severe spinal deformities. Spine. 2002; 27: 2374-2382
– reference: 17) Cho SK, Lenke LG, Balon SM, et al: Can intraoperative spinal cord monitoring reliably help prevent paraplegia during posterior vertebral column resection surgery. Spine Deform. 2015; 3: 73-81
– reference: 8) Bianco K, Norton R, Schwab F, Smith JS, et al: Complications and intercenter variability of three-column osteotomies for spinal deformity surgery: a retrospective review of 423 patients. Neurosurg Focus. 2014; 36: E18
– reference: 1) Bradford DS: Vertebral column resection. Orthop Trans. 1987; 11: 502
– reference: 15) Lyer S, Nemani VM, Kim HJ: A Review of Complications and Outcomes following Vertebral Column Resection in Adults. Asian Spine J. 2016; 10: 601-609
– reference: 11) Papadopoulos EC, Boachie-Adjei O, Hess WF, et al: Early outcomes and complications of posterior vertebral column resection. Spine J. 2015; 15: 983-991
– reference: 20) Kim AH, Mo KC, Harris AB, et al: High-Dose TXA Is Associated with Less Blood Loss Than Low-Dose TXA without Increased Complications in Patients with Complex Adult Spinal Deformity. J Bone Joint Surg Am. 2024; 106: 2205-2214
– reference: 6) Hamzaoglu A, Alanay A, Ozturk C, et al: Posterior vertebral column resection in severe spinal deformities; a total of 102 cases. Spine. 2011; 36: E340-E344
– reference: 12) Zhang HQ, Li JS, Liu SH, et al: The use of posterior vertebral column resection in the management of severe posttuberculous kyphosis: a retrospective study and literature review. Acta Orthop Trauma Surg. 2013; 133: 1211-1218
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Snippet はじめに：近年，成人脊柱変形や高度脊柱変形の手術は目覚ましい発展があるが，そのなかで最も難度の高い手術がVertebral Column Resection（VCR）に代表されるThree...
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成人脊柱変形
椎体骨切り術
Title 成人脊柱変形に対するVertebral Column Resection（VCR）の成績と合併症について
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