Single-Stage Posterior Hemivertebra Resection with Transpedicular Instrumented Fusion for Correction of Congenital Scoliosis

Abstract

Background Data: Congenital scoliosis may be caused by failure of formation, failure of segmentation, or by a combination of these 2 factors, resulting in a mixed deformity. Complete failure of formation results in a hemivertebra. There is a debate on the method of treatment and whether operate with or without fusion. Nevertheless there is no debate about the early treatment. Congenital scoliosis due to hemivertebra is difficult to control and may progress after non-operative and even after operative management. Hemivertebra resections in older children often require a long fusion segmentbecause of secondary structural curves that may be avoided with early management. Purpose: Assessment of surgical intervention in congenital scoliosis by posterior approach with transpedicular instrumentation. Study Design: Retrospective clinical case study. Patients and Methods: Thirty five consecutive cases of congenital scoliosis in young children were operated on by hemivertebra resection by a posterior-only approach with transpedicular instrumentation. Meanage at time of surgery was eight years. The mean follow-up was 26 months. Results: Mean Cobb angle of the main curve was 55.8° before surgery, and 13° at latest follow-up. On average three segments were fused. There was one infection, two pedicle fractures, and three implant failures. In two patients additional operations were performed because of new developing deformities. Conclusion: Correction surgery of congenital scoliosis should be performed early,before the development of severe local deformities and secondary structural changes, especially in patients with expected deterioration. Posterior resection of the hemivertebra with transpedicular instrumentation allows for early intervention in young children. Excellent correction in the frontal and sagittal planes, and a short segment of fusion allows for normal growth in the unaffected parts of the spine. (2016ESJ115)