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What Is Vertebral Column Resection?

Vertebral column resection is an extensive three-column spinal osteotomy in which one or more vertebral segments are removed to correct a severe rigid deformity. It is commonly abbreviated VCR. The procedure removes the vertebral body together with posterior elements at the treated level, allowing the spinal column to be shortened, translated, and realigned in multiple planes. Because it provides greater corrective power than less extensive osteotomies, VCR is reserved for complex deformities that cannot be corrected safely with simpler techniques.

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What Is Vertebral Column Resection?

Vertebral column resection is an extensive three-column spinal osteotomy in which one or more vertebral segments are removed to correct a severe rigid deformity. It is commonly abbreviated VCR. The procedure removes the vertebral body together with posterior elements at the treated level, allowing the spinal column to be shortened, translated, and realigned in multiple planes. Because it provides greater corrective power than less extensive osteotomies, VCR is reserved for complex deformities that cannot be corrected safely with simpler techniques.

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Why Is Vertebral Column Resection Performed?

VCR is used for selected patients with severe fixed scoliosis, kyphosis, angular deformity, congenital spinal abnormalities, or major deformity after previous surgery. It can be considered when the spine is too rigid for correction through disc releases, posterior-column osteotomies, or pedicle subtraction osteotomy. The procedure can also help reconstruct alignment after selected destructive spinal lesions when removal of a vertebral segment is required. Because neurologic injury, major blood loss, and mechanical complications are substantial concerns, the operation is generally performed at specialized deformity centers after detailed imaging and multidisciplinary planning.

How Is Vertebral Column Resection Performed?

The surgeon usually approaches the spine from the back and places temporary and permanent fixation above and below the planned resection. The posterior elements, pedicles, and most or all of the vertebral body are removed while the spinal cord and nerve roots are carefully protected. A structural cage or graft is placed into the resulting anterior-column defect, and rods are gradually adjusted to close, translate, or rotate the spine into the planned alignment. Bone graft and long-segment instrumentation are then used to stabilize the corrected spine while fusion develops.

What Is Recovery Like After Vertebral Column Resection?

Recovery is intensive because VCR is usually part of a long and complex spinal reconstruction. Patients are monitored closely for neurologic function, blood loss, cardiopulmonary status, wound healing, pain, and the stability of the reconstructed spine. Walking and rehabilitation begin gradually, while bending, lifting, and strenuous activity remain restricted during fusion. Functional recovery and adaptation to the corrected alignment can continue for many months, with long-term imaging used to monitor fusion and hardware integrity.

What Are the Risks and Complications?

VCR has one of the highest complication profiles among spinal-deformity procedures. Risks include major blood loss, infection, dural tear, nerve-root injury, spinal-cord injury, paralysis, blood clots, pulmonary complications, and other medical complications from prolonged surgery. Long-term problems include pseudarthrosis, rod breakage, implant failure, proximal junctional kyphosis or failure, and loss of correction. Published series also report substantial rates of revision surgery, so patient selection and experienced deformity care are critical.

Frequently Asked Questions About Vertebral Column Resection

How is vertebral column resection different from pedicle subtraction osteotomy?

VCR removes an entire vertebral segment across all three spinal columns, while pedicle subtraction osteotomy removes a wedge from one vertebra and closes it around an intact anterior hinge.

Why is VCR used only for severe deformity?

It provides very large multiplanar correction but also carries substantial blood-loss, neurologic, and mechanical risks compared with less extensive osteotomies.

Is a cage used after vertebral column resection?

Yes. A structural cage or graft is commonly placed into the anterior-column defect to support the spine after the vertebral body has been removed.

Can vertebral column resection require revision surgery?

Yes. Nonunion, rod breakage, junctional failure, infection, neurologic problems, or loss of alignment can require later revision surgery.

References

Posterior vertebral column resection in spinal deformity: a systematic review. PubMed. https://pubmed.ncbi.nlm.nih.gov/25599850/. Date Accessed September 11, 2026.

A Review of Complications and Outcomes following Vertebral Column Resection in Adults. PubMed. https://pubmed.ncbi.nlm.nih.gov/27340543/. Date Accessed September 11, 2026.

State of the art review: Vertebral Osteotomies for the management of Spinal Deformity. PubMed. https://pubmed.ncbi.nlm.nih.gov/32468384/. Date Accessed September 11, 2026.

Vertebral Column Resection for Rigid Spinal Deformity. PubMed. https://pubmed.ncbi.nlm.nih.gov/28660112/. Date Accessed September 11, 2026.

The Technique for Performing Posterior Vertebral Column Resection with En-Bloc Fixation/Reduction in Adult Spine Deformity Surgery. PubMed. https://pubmed.ncbi.nlm.nih.gov/35685239/. Date Accessed September 11, 2026.