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Adult Spinal Deformity Surgery
Vertebral Column Resection (VCR)
An in-depth, evidence-based explanation of vertebral column resection — the most powerful correction available, reserved for the most severe, rigid spinal deformities.
Vertebral column resection, or VCR, is the most powerful deformity correction in spinal surgery, and is reserved for the most severe and rigid deformities that cannot be corrected by other means. In a VCR, an entire vertebra — the whole bony ring, front and back — is removed, allowing the spine above and below to be realigned and reconstructed. This permits correction in every plane and is used for the sharpest, stiffest curves and angular deformities. Because it is such a large undertaking with a real neurological risk, it is used selectively, with meticulous technique and monitoring. This page explains what it involves and what the evidence shows.
For information only — not medical advice. The content on this page is patient education to help you understand a condition or treatment. It is not a substitute for personalised assessment by a qualified clinician. Always consult your doctor or specialist about your own symptoms, diagnosis, and treatment decisions.
When a VCR is used
A VCR is reserved for severe, rigid deformities where lesser techniques cannot achieve the correction needed — for example very sharp angular kyphosis or scoliosis, congenital deformities, and some fixed, complex or previously operated spines. It is chosen when the deformity is so stiff and severe that removing a whole segment is the only way to realign the spine and take pressure off the spinal cord. Because of its power and its risks, it is used only when the severity of the problem justifies it.
What the operation involves
A VCR is usually performed from the back, though a combined approach is sometimes used. The entire vertebra at the apex of the deformity — its body and the bony arch behind — is removed, temporarily leaving a gap that is protected by strong instrumentation. The spine is then realigned and the gap reconstructed with a cage or strut and bone graft, restoring a stable, better-aligned column. Because the spinal cord is exposed and the correction is large, the procedure demands exacting technique and continuous neuromonitoring, and the degree of angulation is assessed carefully, as it relates to neurological risk.
What the evidence shows
The evidence, much of it from large specialist series, establishes the VCR as an effective correction for severe rigid deformity while being clear about its demands. Landmark series report powerful, durable correction of severe scoliosis, kyphosis and fixed lumbosacral deformity, and later work with long-term follow-up confirms lasting results. Importantly, the literature has defined how the sharpness of the deformity (the deformity angular ratio) predicts the risk of neurological injury, which guides planning and monitoring. The balanced view is that the VCR is the most powerful tool available for the most severe deformities, used selectively and with great care.
What to expect
A VCR is major surgery, carried out under general anaesthetic, usually with a hospital stay of several days or more and a recovery measured in months, supported by a structured rehabilitation programme. The correction is achieved during surgery and held by the metalwork while the reconstruction fuses over the following months. Because it carries significant risks, including a neurological risk that is actively managed with monitoring, the decision is made carefully and the risks and expectations are discussed fully beforehand. Whether a VCR is the right choice for a given deformity is decided together.
The information provided on this page is intended for educational purposes only and should not be considered personalised medical advice. Every patient is different, and treatment options, risks, expected recovery and outcomes depend upon an individual's diagnosis, deformity, general health and personal circumstances. Decisions regarding treatment should always be made following consultation with your treating spinal surgeon or healthcare professional.
Evidence & further reading
- —Suk SI, et al. Posterior vertebral column resection for severe spinal deformities. Spine 2002. (PMID 12438987)
- —Suk SI, et al. Posterior vertebral column resection for severe rigid scoliosis. Spine 2005. (PMID 16025041)
- —Suk SI, et al. Posterior vertebral column resection in fixed lumbosacral deformity. Spine 2005. (PMID 16319740)
- —Wang Y, Lenke LG, et al. Deformity angular ratio predicts neurologic deficit risk in posterior vertebral column resection. Spine 2016. (PMID 26953665)
- —Riley MS, Lenke LG, et al. Clinical and radiographic outcomes after posterior vertebral column resection for severe deformity, minimum 5-year follow-up. J Bone Joint Surg Am 2018. (PMID 29509617)
- —Saifi C, Lenke LG, et al. Vertebral column resection for rigid spinal deformity. Global Spine J 2017. (PMID 28660112)
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