Surgical treatment of congenital vertebral displacement Type A in the sagittal plane only: a retrospective study involving eleven cases.

Abstract

The essence of congenital vertebral displacement Type A pathology is a congenital structure defect including a vertebral or intervertebral disc with instant curvature of the spinal canal in the sagittal plane. Clinically this defect assumes the shape of kyphosis or kyphoscoliosis. A retrospective review of 11 patients with this congenital deformity was conducted. To evaluate the effectiveness of surgical treatment for congenital vertebral displacement, and to establish the optimal operative management. Nine patients with a mean age of 3.3 years (range, 1.8-5.5 years) underwent surgery. Two patients were treated conservatively. All the patients underwent radiologic investigation, which included radiographs, three-dimensional computed tomography scans, and magnetic resonance imaging scans. The neurologic condition was assessed by clinical neurologic examination and somatosensory-evoked potentials. The following surgical techniques were performed: 13 posterior fusions in situ in eight patients; 4 anterior fusions in situ in four patients, 8 total or partial vertebrectomies with anterior fusion and stabilization using cylindric cage in 6 patients, 3 total or partial vertebrectomies with anterior fusion and stabilization using fibula graft in 3 patients, and 5 posterior fusions with instrumentation in 2 patients. The total mean follow-up period was 5.7 years (range, 2.1-9.9 years). The mean follow-up period after the last operation was 22 months (range, 2-48 months). The general results observed during the follow-up period were as follows. Deformity stabilization was obtained in six patients, whereas it was still progressive in three patients. In five patients, regression of neurologic deficits was obtained, whereas in patients, it was stable. Progression of neurologic deficits was observed in one patient (paraplegia). Retrospectively, the best clinical results were achieved after extensive decompression of the spinal cord with anterior stabilization of the spine using a cylindric cage or fibula autograft. These procedures were preceded or followed by posterior fusion. The findings showed that only extensive vertebrectomy and anterior stabilization using a cylindric cage or fibula graft combined in one operative procedure, preceded or followed by posterior fusion, ensures patients against progression of neurologic deficits and deformity of spine.