Efficacy of Hemivertebra Resection for Congenital Scoliosis A Multicenter Retrospective Comparison of Three Surgical Techniques
ABSTRACT Multicenter, retrospective study.
To compare the outcomes of three surgical treatments for congenital spinal deformity due to a hemivertebra.
Congenital anomalies of the spine can cause significant and progressive scoliosis and kyphosis. Their management may be challenging and controversy remains over the "best" surgical treatment.
A multicenter retrospective study of patients with congenital spinal deformity due to 1 or 2 level hemivertebra(e) was performed. The surgical treatments included hemiepiphysiodesis or in situ fusion (group 1), instrumented fusion without hemivertebra excision (group 2), or instrumented hemivertebra excision (group 3).
Seventy-six patients with minimum 2-year follow-up were evaluated. The mean age was 8 years (range: 1-18). The hemivertebra were fully segmented, nonincarcerated (67%), incarcerated (1%), and semisegmented (32%). There were 65 patients with single hemivertebra and 11 patients with double hemivertebra. There were 14 (18.4%) group 1, 20 (26.3%) group 2, and 42 (55.3%) group 3 patients. Group 1 (37 ± 14°) and group 3 (35 ± 26°) patients had smaller preoperative curves than group 2 patients (55 ± 26°) (P < 0.01). Group 3 had better percent correction at 2 years than groups 1 and 2 (P < 0.001). Group 3 had shorter fusion (P = 0.001), less estimated blood loss (EBL, P = 0.03), and a trend toward shorter operative times than group 2 (P = 0.10). The overall complication rate for the entire group was 30% group 1 (23%), group 2 (17%), and group 3 (44%) (P = 0.09).
While hemivertebra resection for congenital scoliosis had a higher complication rate than either hemiepiphysiodesis/in situ fusion or instrumentated fusion without resection, posterior hemivertebra resection in younger patients resulted in better percent correction than the other two techniques.
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ABSTRACT: PURPOSE: Until now there have been many reports on hemivertebra resection. But there were no large series on the posterior hemivertebra resection with bisegmental fusion. This is a retrospective study to evaluate the surgical outcomes of posterior hemivertebra resection only with bisegmental fusion for congenital scoliosis caused by fully segmented non-incarcerated hemivertebra. METHODS: In our study, 36 consecutive cases (19 males, 17 females) diagnosed with congenital scoliosis, resulting from fully segmented non-incarcerated hemivertebra, treated by posterior hemivertebra resection with bisegmental fusion were investigated retrospectively, with at least a 3 year follow-up period (36-106 months). RESULTS: The total number of resected hemivertebra was 36. Mean operation time was 188.6 min with average blood loss of 364.2 ml. The segmental scoliosis was corrected from 36.6° to 5.1° with a correction rate of 86.1 %, and segmental kyphosis(difference to normal segmental alignment) from 21.2° to 5.8° at the latest follow-up. The correction rate of the compensatory cranial and caudal curve is 76.4 and 75.1 %. Unanticipated surgeries were performed on eight patients, including one delayed wound healing, two pedicle fractures, one progressive deformity and four implants removals. CONCLUSIONS: Posterior hemivertebra resection with bisegmental fusion allows for early intervention in very young children. Excellent correction can be obtained while the growth potential of the unaffected spine could be preserved well. However, it is not indicated for the hemivertebra between L5 and S1. The most common complication of this procedure is implant failure. Furthermore, in the very young children we noted that although solid fusion could be observed in the fusion level, implants migration may still happen during the time of adolescence, when the height of the body developed rapidly. So a close follow-up is necessary.European Spine Journal 11/2012; DOI:10.1007/s00586-012-2577-4 · 2.47 Impact Factor
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ABSTRACT: To assess the correction effect of hemivertebra resection for unbalanced multiple hemivertebrae by measuring corresponding parameters in both coronal and sagittal planes on series posteroanterior and lateral radiographs and report the related complications. Twelve children with unbalanced multiple hemivertebrae were operated on by hemivertebra resection through a combined anterior and posterior approach or a posterior-only procedure. Mean age at time of surgery was 9.8 years (range 2-14 years). They were retrospectively studied with a mean follow-up of 48.7 months (range 30-60 months). The mean Cobb angle of the main curve was 65.3° (range 45°-92°) before surgery and 13.8° (range 4°-30°) at the last follow-up. The correction rate was 80.0 % (range 65.5-92.4 %). The compensatory cranial curve was corrected from 25.8° (range 5°-53°) to 11.7° (range 0°-34°) with a correction rate of 65.9 % (range 33.3-100 %), and the compensatory caudal curve was corrected from 32.4° (range 17°-57°) to 7.1° (range 0°-20°) with a correction rate of 81.4 % (range 53.1-100 %). The angle of segmental kyphosis was 41.3° (range 12°-76°) before surgery and 17.0° (range -12° to 45°) at the final follow-up. The coronal imbalance was -1.0 cm (range -3.5 to 3 cm) before surgery and 0.0 cm (range -1.0 to 1.5 cm) at the most recent follow-up. The sagittal imbalance was 0.9 cm (range -3.2 to 3 cm) before surgery and 0.6 cm (range -3.0 to 3.5 cm) at the most recent follow-up. Complications including pedicle fractures, and pseudarthrosis were found in two patients (20 %). In the patients with unbalanced multiple hemivertebrae, hemivertebra resection allows for excellent correction in both the coronal and sagittal planes, and great care should be taken to reduce the rate of complications.European Spine Journal 10/2013; 23(3). DOI:10.1007/s00586-013-3065-1 · 2.47 Impact Factor
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ABSTRACT: Although effective correction of deformity in congenital scoliosis can often be achieved with instrumentation only and without more invasive techniques such as hemivertebrectomy, reports on the feasibility of correction with instrumentation only are lacking. To compare the results of deformity correction using instrumentation only versus hemivertebrectomy, and to examine the feasibility of and indications for correction with instrumentation only in patients with congenital scoliosis. Twenty-five patients underwent correction with either instrumentation only (n = 14) or hemivertebrectomy (n = 11). The two patient groups were compared in terms of age at the time of surgery, preoperative magnitude and flexibility of the main curve, correction rates after surgery and at the final follow-up, surgery time, estimated blood loss, and complications. The two groups did not differ significantly in terms of average patient age or curve magnitude, but the correction with the instrumentation-only group had greater preoperative curve flexibility (37.1%) than the hemivertebrectomy group (21.0%). The correction rates immediately after surgery were high in both groups. The correction with instrumentation only group had a shorter mean operation time (308 versus 366 minutes) and less blood loss (540 versus 1547 mL) than the hemivertebrectomy group. Satisfactory correction of congenital scoliosis can be obtained with instrumentation only if there is adequate flexibility in the main curve, thus avoiding the need for more invasive procedures such as hemivertebrectomy.Neurosurgery 10/2013; 74(1). DOI:10.1227/NEU.0000000000000194 · 3.03 Impact Factor