Paper #15 Total Hemivertebra Resection by Posterior Approach in Congenital Scoliosis and Kyphoscoliosis: Results with 7 Years Mean Follow Up

Abstract Background Treatment of congenital hemivertebra is challenging and data on long-term follow-up (≥ 5 years) are lacking. This study evaluated the surgical outcomes of posterior thoracolumbar hemivertebra resection and short-segment fusion with pedicle screw fixation for treatment of congenital scoliosis with over 5-year follow-up. Methods This study evaluated 27 consecutive patients with congenital scoliosis who underwent posterior thoracolumbar hemivertebra resection and short-segment fusion from January 2007 to January 2015. Segmental scoliosis, total main scoliosis, compensatory cranial curve, compensatory caudal curve, trunk shift, shoulder balance, segmental kyphosis, and sagittal balance were measured on radiographs. Radiographic outcomes and all intraoperative and postoperative complications were recorded. Results The segmental main curve was 40.35° preoperatively, 11.94° postoperatively, and 13.24° at final follow-up, with an average correction of 65.9%. The total main curve was 43.39° preoperatively, 14.13° postoperatively, and 16.06° at final follow-up, with an average correction of 60.2%. The caudal and cranial compensatory curves were corrected from 15.78° and 13.21° to 3.57° and 6.83° postoperatively and 4.38° and 7.65° at final follow-up, with an average correction of 69.2% and 30.3%, respectively. The segmental kyphosis was corrected from 34.30° to 15.88° postoperatively and 15.12° at final follow-up, with an average correction of 61.9%. A significant correction (p < 0.001) in segmental scoliosis, total main curve, caudal compensatory curves and segmental kyphosis was observed from preoperative to the final follow-up. The correction in the compensatory cranial curve was significant between preoperative and postoperative and 2-year follow-up (p < 0.001), but a statistically significant difference was not observed between the preoperative and final follow-up (p > 0.001). There were two implant migrations, two postoperative curve progressions, five cases of proximal junctional kyphosis, and four cases of adding-on phenomena. Conclusion Posterior thoracolumbar hemivertebra resection after short-segment fusion with pedicle screw fixation in congenital scoliosis is a safe and effective method for treatment and can achieve rigid fixation and deformity correction.

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Hemivertebra resection with posterior unilateral intervertebral fusion and transpedicular fixation for congenital scoliosis: results with at least 3 years of follow-up

European Spine Journal ◽

10.1007/s00586-016-4556-7 ◽

2016 ◽

Vol 25 (10) ◽

pp. 3274-3281 ◽

Cited By ~ 7

Author(s):

Yi Feng ◽

Yong Hai ◽

Sheng Zhao ◽

Lei Zang

Keyword(s):

Congenital Scoliosis ◽

Intervertebral Fusion ◽

Transpedicular Fixation ◽

Hemivertebra Resection

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Posterior hemivertebra resection and monosegmental fusion in the treatment of congenital scoliosis

Annals of The Royal College of Surgeons of England ◽

10.1308/003588414x13824511650173 ◽

2014 ◽

Vol 96 (1) ◽

pp. 41-44 ◽

Cited By ~ 7

Author(s):

X Zhu ◽

X Wei ◽

J Chen ◽

C Li ◽

M Li ◽

...

Keyword(s):

Cobb Angle ◽

Sagittal Plane ◽

Congenital Scoliosis ◽

Coronal Plane ◽

X Ray ◽

Hemivertebra Resection ◽

The Mean ◽

Whole Spine

INTRODUCTION Posterior hemivertebra resection combined with multisegmental or bisegmental fusion has been applied successfully for congenital scoliosis. However, there are several immature bones and their growth can be influenced by long segmental fusion in congenital patients. Posterior hemivertebra resection and monosegmental fusion was therefore suggested for treatment of congenital scoliosis caused by hemivertebra. METHODS Between June 2001 and June 2010, 60 congenital scoliosis patients (aged 2–18 years) who underwent posterior hemivertebra resection and monosegmental fusion were enrolled in our study. A standing anteroposterior x-ray of the whole spine was obtained preoperatively, postoperatively and at the last follow-up appointment to analyse the Cobb angle in the coronal and sagittal planes as well as the trunk shift. RESULTS The mean preoperative coronal plane Cobb angle was 41.6°. This was corrected to 5.1° postoperatively and 5.3° at the last follow-up visit (correction 87.3%). The compensatory cranial curve was improved from 18.1° preoperatively to 7.1° postoperatively and 6.5° at the last follow-up visit while the compensatory caudal curve was improved from 21.5° to 6.1° after surgery and 5.6° at the last follow-up visit. The mean sagittal plane Cobb angle was 23.3° before surgery, 7.3° after surgery and 6.8° at the last follow-up visit (correction 70.1%). The trunk shift of 18.5mm was improved to 15.2mm. CONCLUSIONS Posterior hemivertebra resection and monosegmental fusion seems to be an effective approach for treatment of congenital scoliosis caused by hemivertebra, allowing for excellent correction in both the frontal and sagittal planes.

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Lumbar hemivertebra resection by posterior approach for congenital scoliosis

European Spine Journal ◽

10.1007/s00586-012-2569-4 ◽

2012 ◽

Vol 21 (12) ◽

pp. 2721-2723 ◽

Cited By ~ 5

Author(s):

Ibrahim Obeid ◽

Anouar Bourghli ◽

Jean-Marc Vital

Keyword(s):

Posterior Approach ◽

Congenital Scoliosis ◽

Hemivertebra Resection

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Hemivertebra Resection Via Posterior Approach In Children Under Age of Five Years with More than Five-Years Follow-Up

The Spine Journal ◽

10.1016/j.spinee.2013.07.345 ◽

2013 ◽

Vol 13 (9) ◽

pp. S134

Author(s):

Sinan Kahraman ◽

Meric Enercan ◽

Cagatay Ozturk ◽

Gurkan Gumussuyu ◽

Wael Alkasem ◽

...

Keyword(s):

Posterior Approach ◽

Hemivertebra Resection

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The radiological outcomes of one-stage posterior-only hemivertebra resection and short segmental fusion for lumbosacral hemivertebra: a minimum of 5 years of follow-up

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-019-1482-5 ◽

2019 ◽

Vol 14 (1) ◽

Author(s):

Yu Wang ◽

Zhen Liu ◽

Changzhi Du ◽

Benlong Shi ◽

Xu Sun ◽

...

Keyword(s):

Congenital Scoliosis ◽

Long Term Outcomes ◽

Short Term ◽

One Stage ◽

Hemivertebra Resection ◽

Age At Surgery ◽

The Mean ◽

Upper Instrumented Vertebra

Abstract Background Previous studies have reported favorable short-term outcomes after posterior-only hemivertebra resection and short fusion in patients with LSHV. However, there is a paucity of data evaluating the long-term outcomes following this procedure. The aim of the study is to evaluate the radiological outcomes following posterior-only hemivertebra resection and short fusion for the treatment of congenital scoliosis (CS) secondary to lumbosacral hemivertebra (LSHV) with a minimum of a 5-year follow-up. Methods A total of 23 patients treated with one-stage posterior-only LSHV resection and short fusion with a minimum of a 5-year follow-up were reviewed. Radiographic parameters including the Cobb angles of the lumbosacral curve and compensatory curve, the upper instrumented vertebra (UIV) tilt, and trunk shift were measured. The complications were recorded accordingly. Results The mean duration of follow-up was 88.6 ± 28.5 months, and the average age at surgery was 7.8 ± 3.5 years. Fusion levels averaged 3.0 ± 0.7 segments. The lumbosacral curve was corrected from 30.7 ± 10.4° to 6.7 ± 7.1° after surgery (P < 0.001), 7.3 ± 6.1° 2 years after surgery, and 8.1 ± 7.0° at the last follow-up. The compensatory curve was spontaneously corrected from 23.7 ± 9.4° before surgery to 8.3 ± 5.2° after surgery (P < 0.001). However, the angle slightly increased to 9.0 ± 4.8° 2 years after surgery and to 9.6 ± 6.4° at the last follow-up. Trunk shift was improved from 27.3 ± 8.6 mm before surgery to 11.7 ± 9.4 mm after surgery, and it decreased to 10.8 ± 8.2 mm 2 years after surgery and 10.4 ± 8.8 mm at the last follow-up. One patient experienced transient neurologic deficits after surgery. One patient was observed to have screw loosening at 1-year follow-up and received revision surgery. Conclusion One-stage posterior-only hemivertebra resection with short fusion is an effective procedure for LSHV, and the correction can be well maintained during longitudinal follow-up. Great attention should be paid to the restoration of lumbosacral horizontalization.

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