P90. The surgical strategy of treatment lumbosacral hemivertebra: comparative analysis of under 10 years old and older than 10 years old groups with five years follow up

Abstract

BACKGROUND CONTEXT The lumbosacral hemivertebra usually leads to the early rapid progress of spinal deformity, shift and large compensatory curve. Compensatory curve of lumbosacral deformities in the early stage of less than 10 years old is often more flexible, while the compensatory curve in children older than 10 usually turns into a structural curve and surgical treatment of deformity in different age is not entirely the same. However, the timing and strategy of lumbosacral hemivertebral surgery in different ages are still controversial. PURPOSE To analyze and compare the surgical strategies and long-term outcomes of lumbosacral hemivertebra deformities in different age groups. STUDY DESIGN/SETTING A retrospective study. PATIENT SAMPLE Eighteen patients with lumbosacral hemivertebra deformity were retrospectively reviewed between 2004 and 2013. OUTCOME MEASURES Clinical and imaging data were collected for statistical analysis. METHODS Patients received a minimum 5-year follow-up and assigned into two groups: Group A (N=8, mean age 6.6 years old) patients who were under 10 years old and underwent hemivertebral resection and short segment fixation, Group B (N=10, mean age 14.3 years old) patients who were older than 10 years old and underwent hemivertebral resection, long segment fixation including compensatory curve. RESULTS Mean follow-up was 6.2 years. In group B all patients were treated with long segment and iliac screw fixation while no iliac screw fixation in group A. The Cobb angle of coronal main curve in group A improved from 31.3° to 9.3° post-op, and to 9.5° at final follow-up. The Cobb angle of coronal main curve in group B improved from 51.5° to 15.5°post-op, and to 16.3°at final follow-up.The Cobb angle of compensatory cranial curve in group A was 23.5° before operation, 13.7°after operation, 16.2° at final follow-up, while in group B 40.5° before operation, 13.3° after operation, 13.8° at final follow-up. CSVL in group A improved from 1.5cm before operation to 0.7 cm at final follow-up and in group B improved from 2.1 cm to 0.9 cm. Fixed fusion segments were 2.1 in group A and 5.6 in group B. The mean operative time and blood loss in Group A was 189 minutes and 380 ml, respectively, and in group B 265 minutes and 750 ml, respectively. The mean operative time and blood loss in group B were statistically significant more than group A. CONCLUSIONS Lumbosacral hemivertebra deformity under 10 years old with flexible compensatory curve undergo short-segment fixation can achieve satisfactory correction, long term maintenance. While older than 10 years old with structural compensatory curve requires long segmental and iliac bone fixation in order to achieve trunk balance and deformity correction and more operative time, blood loss and complications. Early surgical treatment is recommended for lumbosacral hemivertebral deformity. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.