Hemivertebra resection by a posterior approach: innovative operative technique and first results.

Abstract

A retrospective study was conducted, with clinical evaluation of hemivertebra resection using transpedicular instrumentation by a posterior approach in young children. To assess a new method of early intervention in congenital scoliosis by a posterior approach. Previously described surgical procedures are fusion in situ, hemiepiphyseodesis and arthrodesis, "growing" instrumentations, and hemivertebra resections performed by a combined anterior and posterior approach. For this study, 21 consecutive cases of congenital scoliosis managed by hemivertebra resection using a posterior approach only with transpedicular instrumentation were investigated retrospectively, with at least a 2-year follow-up period. Surgery was performed in patients who had congenital scoliosis with proven or expected deterioration, or pain resulting from the malformation. The mean Cobb angle of the main curve was 41 degrees before surgery, 14 degrees after surgery, and 15 degrees at the latest follow-up assessment. The angle of kyphosis was 24 degrees before surgery, but improved to 11 degrees after surgery. There was one infection, one pedicle fracture, and two failures of the initially used wire instrumentation. Posterior resection of hemivertebrae with transpedicular instrumentation is a safe and promising procedure that offers significant advantages for controlling congenital deformity: excellent correction in both the frontal and sagittal planes, short segment of fusion, high stability, no need for an anterior approach, and low neurologic risk. Surgery should be performed as early as possible to avert severe local deformities, to prevent secondary structural changes, and to avert extensive fusions.