Abstract
BackgroundTreatment 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.MethodsThis 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.ResultsThe 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.ConclusionPosterior 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.
Highlights
Treatment of congenital hemivertebra is challenging and data on long-term follow-up (≥ 5 years) are lacking
Congenital scoliosis is caused by spine abnormalities that lead to imbalanced growth
Surgical treatment modalities include in situ posterior spinal fusion, combined anterior and posterior in situ spinal fusion, hemivertebra resection [4], and guided growth procedures such as growing rods [5], Vertical Expandable Prosthetic Titanium Rib (VEPTR, SYNTHES Spine) [6], and Shilla [7] procedures
Summary
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 shortsegment fusion with pedicle screw fixation for treatment of congenital scoliosis with over 5-year follow-up. Because of local deformity and asymmetric loads, unaffected neighboring vertebrae subsequently show asymmetric growth. This congenital anomaly, apart from causing adverse effects on cardiopulmonary function, causes psychological distress [1]. Surgical treatment modalities include in situ posterior spinal fusion, combined anterior and posterior in situ spinal fusion, hemivertebra resection [4], and guided growth procedures such as growing rods [5], Vertical Expandable Prosthetic Titanium Rib (VEPTR, SYNTHES Spine) [6], and Shilla [7] procedures
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