Introduction: Attention to adult spinal deformity (ASD) has increased over the past few decades, resulting in important clinical advances in its treatment. Three-column osteotomy, including vertebral column resection (VCR), is a powerful method to correct rigid scoliosis. The purpose of this study was to evaluate surgical treatment with VCR.

Patients and Methods: Fourteen patients (3 men and 11 women; mean age 56.2 years) with severe ASD were treated surgically. The mean preoperative Cobb angle was 71.8°. The preoperative diagnoses included revision scoliosis surgery due to curve progression in seven patients, ASD with known scoliosis in adolescence in four patients, de novo ASD in two patients, and congenital kyphosis in one patient. All patients complained of back pain, one had spinal cord injury with complete paraplegia, and two patients had muscle spasticity and difficulty walking. According to the ASD SRS-Schwab classification, seven patients were classified with marked sagittal imbalance (SVA>9.5 cm, PT>30°, PI-LL>20°).

Results: Thirteen of 14 patients underwent single-stage posterior VCR. One patient had two-stage VCR. The level of the resected vertebra was L1 in seven patients, T12 in two patients, L2 in two patients, and T8, 9, or 11 in one patient each. The mean postoperative Cobb angle was 30.8°, corresponding to a mean correction rate of 57.2%. In two patients, marked sagittal imbalance remained. The mean preoperative blood transfusion was 1,800 ml, and the mean estimated intraoperative blood loss was 5,129 ml. Six patients required homologous blood transfusions, five patients had surgical complications, two had respiratory dysfunction, two had temporary neurological complications, and one patient developed a surgical site infection.

Conclusion: Although the rate of complications was high, VCR surgery for patients with ASD can be used effectively even for revision scoliosis surgery. The routine use of high-dose tranexamic acid might reduce blood loss.