Through a posterior-only or combined anterior-posterior approach, pedicle screws are placed above and below the planned resection. The vertebral body, both pedicles, and both laminae are completely removed — the spinal cord is left suspended in space. The spine is then shortened, translated, and rotated into the corrected position. A cage or structural graft is placed anteriorly. The correction is held with rods. Neuromonitoring is essential throughout. The operation takes six to twelve hours.
VCR is reserved for the most severe spinal deformities — rigid kyphosis exceeding 80 degrees, rigid kyphoscoliosis not correctable by osteotomy, congenital hemivertebra causing severe deformity, post-infectious spinal collapse, and revision of failed previous deformity correction.
Bracing (ineffective for rigid deformity), observation (if deformity is not progressive or functionally limiting), and lesser osteotomies (Smith-Petersen, pedicle subtraction — if sufficient correction is achievable).
Full-length standing spinal X-rays, CT with 3D reconstruction, MRI of the entire spine. Pulmonary function tests (severe kyphosis impairs breathing). Nutritional assessment. Blood bank preparation. ICU bed booked. This is performed only at specialist spinal deformity centres.
Correction of severe, rigid deformity. Improved cosmesis, pulmonary function, and sagittal balance. Prevention of neurological deterioration from progressive deformity.
Major surgeryExpected
One of the most extensive spinal operations with significant physiological stress.
Blood lossExpected
Average blood loss three to five litres. Transfusion always required.
Prolonged ICU stayExpected
ICU for 24–72 hours minimum.
Prolonged hospital stayExpected
One to three weeks.
Neurological deficitUncommon
Risk of spinal cord injury approximately 5–10%. The cord is at maximal risk during the correction manoeuvre.
Wound infectionUncommon
Approximately 5–10% for these complex procedures.
PseudarthrosisUncommon
Non-union at the resection site.
Implant failureUncommon
Rod breakage or screw pull-out.
Proximal junctional kyphosisCommon
New kyphosis above the construct.
Medical complicationsCommon
Pneumonia, DVT/PE, cardiac events.
MortalityRare
Reported mortality approximately 1–3% for VCR.
General anaesthesia. Full neuromonitoring (SSEPs, MEPs, EMG). Invasive arterial and central venous monitoring. Cell salvage. Planned ICU admission. Positioned prone for extended periods — meticulous pressure point care.
ICU for 24–72 hours. Hospital one to three weeks. TLSO brace for three to six months. Gradual mobilisation. Pulmonary physiotherapy. Full recovery six to eighteen months. Long-term spinal surveillance.
Frequent early reviews. Standing full-spine X-rays at six weeks, three months, six months, one year, then annually for five years.
Why is this so risky?
VCR involves removing an entire vertebral body while the spinal cord passes through it — the cord is essentially suspended in space during the correction. This is the most technically demanding spinal procedure with the highest neurological risk.
Can lesser operations achieve the same correction?
For rigid deformities exceeding 80 degrees or requiring translation/rotation, VCR may be the only option. Lesser osteotomies (PSO, SPO) correct 25–40 degrees per level and are preferred when sufficient. VCR is reserved for when nothing else will work.