Abstract
BackgroundCongenital scoliosis caused by failure of multiply vertebral segmentation with concave fused rib or unsegmented bar combined with contralateralhemivertebra is usually rigid and produces enormous asymmetric growth. Fusionless techniques have less advantage and come with some complications. Paucity of data was reported for children with complex congenital scoliosis using two-staged osteotomy surgery.MethodsFrom 2006 to 2016, 11 patients less than 10 years old undergoing two staged osteotomy surgery for complex rigid congenital scoliosis were retrospectively reviewed. The analysis included age at initial surgery, second surgery and at the latest follow-up, and complications. Changes in coronal major curve, thoracic kyphosis, lumbar lodorsis, apex vertebra translation, T1-T12 length, T1-S1 length, trunk shift, and SVAwere included in radiological evaluation.ResultsIn all, the mean follow-up was 72.5 ± 23.8 (42 to 112) months. The mean flexibility of the spine was 17.4 and 17.8 % before two surgeries. The mean age at the initial surgery was 6.6 ± 2.6 (2.5–10) years. The mean fusion level was 4.6 ± 1.3 (2 to 6) segments. The mean scoliosis improved from 67.4° to 23.7° after initial surgery and was 17.4° at the latest follow-up. The average increase of T1-S1 length was 0.92 cm per year. No patients had neurological complications.ConclusionsTwo-staged osteotomy surgery including hemivertebrae resection or Y-shaped osteotomy can achieve good radiological and clinical outcomes without severe complications. This procedure can be an option of treatment for complex congenital scoliosis.
Highlights
Congenital scoliosis caused by failure of multiply vertebral segmentation with concave fused rib or unsegmented bar combined with contralateralhemivertebra is usually rigid and produces enormous asymmetric growth
For these patients with complex congenital scoliosis due to unilateral failure of multiple vertebral segmentation, unsegmented bar combined with contralateral hemivertebra, or vertebrae anomalies with concave fused rib, their curves are usually rigid, and growth potential is restricted to some extent
Two cases were associated with split spinal cord malformation, presenting as both bony and fiber septum
Summary
Congenital scoliosis caused by failure of multiply vertebral segmentation with concave fused rib or unsegmented bar combined with contralateralhemivertebra is usually rigid and produces enormous asymmetric growth. Zhao et al BMC Musculoskeletal Disorders (2021) 22:788 related complications, wound infection, increased costs due to multiplerepeated procedures, and psychological consequences are of great concern[7,8,9] For these patients with complex congenital scoliosis due to unilateral failure of multiple vertebral segmentation, unsegmented bar combined with contralateral hemivertebra, or vertebrae anomalies with concave fused rib, their curves are usually rigid, and growth potential is restricted to some extent. We have developed two-staged posterior osteotomy surgery in order to reduce patients’ burden and the risk of complications The concept of this technique is to achieve partial curve correction by removing the primary driving force of spine deformity in apex vertebra region. The strategy of correction is based on the gradually improvement from large curve to moderate, and mild or even normal
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