Tratamiento quirúrgico de la escoliosis congénita por hemivértebra aislada. A propósito de una serie de 27 casos

Abstract

Purpose Congenital scoliosis resulting from hemivertebrae can be treated surgically through resection or convex epiphysiodesis. Our purpose was to assess the results obtained in a series of children operated using both methods. Materials and methods A clinical and radiological review was carried out of a non-comparative series of 27 isolated hemivertebrae of which 16 had been treated by means of resection and 11 by means of epiphysiodesis. Mean age at surgery was 50 months (24-132) and Cobb's angle was 33° (20°–75°). In the case of lumbar hemivertebrae, resection was performed through an anterior and posterior approach; compressive CD instruments were used. Epiphysiodesis for the thoracic vertebrae required a prior excision phase at two levels, followed by a subsequent 4-level decortication phase: in 6 cases they were instrumented and in 5 a plaster cast was applied in the reduced position. Results No neurological complication was found. With respect to the 16 resections, mean reduction was 75% postoperatively and 73% at the end of the study. For the 11 epiphysiodeses mean correction obtained was 25% postoperatively and 39% at 4 years’ mean follow-up (1–8 years). There were 2 cases of long-term failure in the absence of instrumentation. Conclusions Resection of hemivertebrae provides immediate and stable satisfactory results. However, in the thoracic area, and given the neurological risk involved, instrumented convex epiphysiodesis guarantees a good long-term result.