Hemivertebra Excision Research Articles

Failure of Posterior Lower Lumbar/Lumbosacral Hemi-Vertebra Resection: An Analysis of Reasons and Revision Strategies.

ObjectiveTo investigate the causes of failed primary surgery and the revision strategies for congenital scoliosis (CS) patients with lower lumbar/lumbosacral (LL/LS) hemi‐vertebra (HV).MethodsFifteen CS patients with LL/LS HV (seven females and eight males) with a mean age of 20.4 ± 10.4 years undergoing revision surgery in our center were retrospectively reviewed. The radiographic parameters including Cobb angle, distance between C7 plumb line and center sacral vertical line (C7PL‐CSVL), thoracic kyphosis (TK), lumbar lordosis (LL) and sagittal vertical axis (SVA) were assessed at pre‐revision, post‐revision and the last follow‐up. The causes of failure in primary operation, and radiographic and clinical outcomes of revision procedures were analyzed.ResultsThe revision rate of patients undergoing LL/LS HV resection and correction surgery was 11.4%. The average time interval between primary surgery and revision surgery was 18.2 ± 10.6 months. The operation duration and estimated blood loss of revision surgery were 194 ± 56 min and 326 ± 74 ml, respectively. Reasons for failed primary operations were as follows: internal fixation fracture in 10 cases, curve progression in two cases, implant loose in two cases and post‐operative coronal imbalance in one case. The post‐revision Cobb angle was significantly improved from 29.9° ± 8.3° to 18.7° ± 6.7° (P < 0.001) with a correction rate of 37.5% ± 12.6%. At the final follow‐up, the average Cobb angle was 18.9° ± 6.2° and the correction was well maintained (P = 0.788). The C7PL‐CSVL at pre‐revision, post‐revision and at last follow‐up were 23.2 ± 9.3 mm, 14.8 ± 4.8 mm and 14.9 ± 5.4 mm, respectively. Significant improvements (P = 0.004) were observed after revision surgery and there was no evident loss of correction (P = 0.703). There was no significant difference in TK, LL and SVA before and after revision surgery (all P > 0.05). At the last follow‐up, no significant correction loss of above coronal and sagittal parameters were observed (all P > 0.05). The revision methods were individualized according to the primary surgical procedures and the reasons for revision. The recommended revision strategies include incision of pseudarthrosis with sufficient bone graft, fixation of satellite rods, thorough residual HV excision, prolonged fusion to S2 and transforaminal lumbar interbody fusion at lumbosacral region. Solid bony fusion and no implant‐related complication were detected during the follow‐up.ConclusionsThe causes of revision surgery for patients with congenital scoliosis (CS) due to lumbosacral HV were verified and implant failure with pseudarthrosis was the main reason for failed primary operation.

Diagnosis and treatment of congenital scoliosis

Background: Congenital scoliosis is caused by anomalies of the vertebra, such as hemivertebra or unsegmented bar, which result in asymmetric growth of the spine. The disruption of vertebra development during embryogenesis may be accompanied by other congenital multi-organ anomalies. The progression of the scoliotic curve may also hinder the development of other organs.Current Concepts: Hemivertebra excision and short spinal fusion have demonstrated favorable outcomes. However, the need for spinal growth and lung development has led to new treatment modalities. Growth-friendly surgeries, such as with a growing rod or vertical expandable rib-based distraction device, have demonstrated good results with curve correction while maintaining spinal growth. Although the outcome of conservative treatment for congenital scoliosis is questionable, casting may be effective as a “time-buying strategy” to delay the need for surgery.Discussion and Conclusion: It is essential to decide on a treatment plan considering the progression of the curve and growth of the spine and lungs through an individualized approach.

Long-term results of hemivertebra excision: How does the spine behave after the peak of puberty?

Early hemivertebra (HV) excision and posterior spinal fusion (PSF) is advocated as the treatment of choice in congenital kyphoscoliosis. We assessed global spinal balance and spinal deformity status once the pubertal peak has taken place, in children with a history of HV excision and PSF at age younger than 5years. Twenty-seven children with congenital kyphoscoliosis without co-existing proximal/distal congenital spinal abnormalities who underwent HV excision and PSF of ≤ 5 levels at age younger than 5years and who had reached the peak of puberty at the last follow-up visit were evaluated. Twenty-seven HV excision were performed. Mean age at surgery was 3years and 2months. A mean of 3.2 segments were fused. Imbalance of the trunk was observed in 80% of thoracic and 75% of thoracolumbar HV excision. No arthrodesis technique (4 cases) presented 100% of spine decompensation. All children younger than 2years at the time of surgery developed spinal imbalance. Eighteen patients (67%) had global spine imbalance; 81% male population and 63% of the female population. Mean age at surgery was 3years + 2months. Mean age of the patients at the time of the study was 15years + 5months. Mean follow-up was 12years + 3months. Many of these patients developed spinal imbalance and scoliosis worsened at the final follow-up. Early age at surgery, preoperative scoliosis severity, HV location, no arthrodesis technique, and the adding-on phenomenon may be involved.

57. Congenital scoliosis patients can attain similar curve correction and perioperative outcomes to AIS patients without the need for hemivertebra excision

BACKGROUND CONTEXT Hemivertebra excision in patients with congenital scoliosis is believed to give the best possible correction. It is, however, a technically challenging procedure and complications can include spinal cord injury, nerve root injury and CSF leak. We have utilized a hemivertebra-sparing approach in these patients alongside multi-level Ponte osteotomies and all pedicle screw constructs. PURPOSE To determine if this approach leads to similar perioperative correction and radiographic outcomes to AIS patients. STUDY DESIGN/SETTING A retrospective case-controlled matched study. PATIENT SAMPLE Twenty-four patients with congenital scoliosis and associated hemivertebra compared with the most recent 54 AIS correction surgeries with 2-year follow-up. OUTCOME MEASURES Curve correction, surgical time, blood loss, complications, length of stay, levels fused, fixation points. METHODS Twenty-four patients with congenital scoliosis and associated hemivertebra were included. These 24 patients were compared with the most recent 54 AIS correction surgeries with 2-year follow-up. An additional rigorous analysis was done to match hemivertebra patients from a database of 330 AIS patients. Patients were matched based on gender, age, BMI, and preop Cobb. Overall, 12 pairs (24 patients) were matched and analyzed. RESULTS When comparing hemivertebra to AIS patients, age (p=0.81), BMI (p=0.24) and preop Cobb (p=0.06) were similar. Postop Cobb (p=0.048) was significantly larger for AIS patients, however, overall Cobb correction was similar (p=0.29). Blood loss was similar (p=0.09) while surgical time (p CONCLUSIONS Patients with hemivertebra can benefit from hemivertebra sparing approach. The XR and periop outcomes were similar to AIS patients. This approach is safer compared to hemivertebra excision with similar or better curve correction than previously reported. Choosing fusion levels on similar principles akin to AIS leads to avoidance of hemivertebra excision in most cases including lumbosacral hemivertebra cases. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

P91. The surgical outcome of hemivertebra excision and short segment fusion treatment for under five years-old congenital scoliosis: 10 years follow-up

BACKGROUND CONTEXT Full segmented hemivertebra with large growth potential can lead to the early rapid progress of spinal deformity. Hemivertebral resection and fixation is an effective method for the treatment of congenital spinal deformity. But there were few studies focusing on the long-term follow-up of the surgical outcome and impact on spinal growth of undergoing hemivertebra resection and short-segment fusion for congenital hemivertebrae under 5 years old. PURPOSE To evaluate the effect of hemivertebra excision and short segment fixation and fusion for congenital spinal deformity under 5 years-old and its impact on spinal growth. STUDY DESIGN/SETTING A retrospective study. PATIENT SAMPLE A consecutive series of 20 patients under 5 years old with hemivertebra deformity undergo hemivertebra resection and short-segment fusion between 2004 and 2008. OUTCOME MEASURES Surgical characteristics, including fusion levels, estimated blood loss, operation duration, main curvature scoliosis, thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA). METHODS All cases were 1-level full segmented hemivertebra and coronal main curve >35° and received a minimum 10-year follow-up. Clinical and imaging data were collected for statistical analysis and evaluation of surgical outcome and impact on spinal growth. RESULTS They were retrospectively studied with a mean follow-up of 11.8 years. There were 12 cases of thoracic hemivertebra and 8 cases of lumbar hemivertebra, mean aged 3.8 years (range, 2.4-5 years). The mean fused segment were 2.1. The mean operative time was 161 min (range: 120 to 320 min). The mean estimated blood loss was 175mL (range: 100 to 400 mL). The Cobb angle of coronal main curve was 39.7° (35-54°) before surgery, 5.4° (0-13°) after surgery, and 6.3° (2-16°) at final follow-up. At final follow-up, the TK angle of thoracic hemivertebra group and lumbar hemivertebra group were 22.4° (6-35°) and 25.6° (8-38°), respectively; the LL angle of lumbar hemivertebra group with 72.1° (58-80°) was significantly larger than thoracic hemivertebra group with 35.5°(24-46°). The SVA of thoracic hemivertebra group and lumbar hemivertebra group were 1.32 cm and 2.1 cm. The height of fixed segmental vertebral body, transverse and longitudinal diameter of fixed segment spinal canal is 92%, 93%, 87% of adjacent segment, respectively. CONCLUSIONS Hemivertebra excision and short-segment fusion for congenital scoliosis under 5 years old can achieve reliable fixation, satisfactory deformity correction and maintained for a long term. It has no significant impact on vertebra growth in fixed segment, but there is more likely to lead to increased lumbar lordosis in lumbar hemivertebra patient which may be related to tethered effect on spine during spinal growth. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

What's New in Congenital Scoliosis?

Congenital scoliosis is a failure of vertebral formation, segmentation, or a combination of the 2 arising from abnormal vertebral development during weeks 4 to 6 of gestation. The associated spinal deformity can be of varying severity and result in a stable or progressive deformity based on the type and location of the anomalous vertebra(e). Bracing for congenital scoliosis is rarely indicated, while recent reports have demonstrated the utility of serial derotational casting for longer curves with multiple anomalous vertebrae as an effective "time buying strategy" to delay the need for surgery. Earlier hemivertebra excision and short-segment posterior spinal fusion have been advocated to prevent future curve progression of the deformity and/or the development of large compensatory curves. It has been shown in recent long-term follow-up studies that growth rates of the vertebral body and spinal canal are not as dramatically affected by pedicle screw instrumentation at a young age as once thought. Growth friendly surgery with either spine-based or rib-based anchors has demonstrated good results with curve correction while maintaining spinal growth. Rib-based anchors are typically more commonly indicated in the setting of chest wall abnormalities and/or when spinal anatomy precludes placement of spinal instrumentation. Recently, magnetically controlled growing rods have shown promising results in several studies that include a small subset of congenital scoliosis cases. A literature search was performed to identify existing studies related to the treatment of congenital scoliosis published from January 1, 2005 to June 1, 2016. Databases included PubMed, Medline, and the Cochrane Library. The search was limited to English articles and yielded 36 papers. This project was initiated by the Pediatric Orthopaedic Society of North America Publications Committee and was reviewed and approved by the Pediatric Orthopaedic Society of North America Presidential Line. A total of 36 papers were selected for review based upon new findings. Classic manuscripts on congenital scoliosis are also included to provide sufficient background information. Congenital scoliosis represents a wide range of pathology from the simple, stable hemivertebra to the complex, progressive spinal deformity with chest wall abnormalities and associated cardiac, renal, and neural axis anomalies. This paper reviews the natural history and associated anomalies with congenital scoliosis as well as the most up-to-date classification schemes and various treatment options for the care of this challenging patient population. Level 5.

Analysis of instrumentation failures after three column osteotomies of the spine

BackgroundCorrection of fixed spinal imbalance in a sagittal and/or coronal plane frequently needs a tricolumnar wedge resection when the deformity is rigid. Complications associated with deformity correction surgery are pseudoarthrosis and implant failure located along the construct. The purposes of this study were to assess comparative rates of pseudoarthrosis (implant failure) at weaker points along lumbosacral junction and level of osteotomy, estimate overall incidence of implant failure, and comparatively analyze failures at different points along the construct.MethodsThis was an IRB approved, single center study retrospective analysis. Twenty-six patients who underwent three column osteotomies were grouped according to procedure: pedicle subtraction osteotomy (PSO, (n = 18)); vertebral column resection (VCR, (n = 4)); hemivertebra excision (HE, (n = 2)); and extracavitary corpectomy (EC, (n = 2)). Follow-up data is presented on all of the study patients. Number of levels of fusion, anchors, percent saturation of fixation levels, type of bone graft and graft substitutes, and rod material and diameter were recorded. Radiographical data was reviewed preoperatively and postoperatively at 2 weeks and 3, 6, and 12 months and annually to determine sagittal and coronal balance, lumbopelvic parameters, presence or absence of interbody structural support, laterality or rod failure, and time to implant failure.ResultsTwenty-seven percent (7/26) patients demonstrated rod breakage either unilaterally (N = 2) or bilaterally (N = 5) during follow-up. Seventy-one percent had increasing back pain or worsening sagittal balance, while remaining failures found incidentally. No failures in children were seen.ConclusionTricolumnar osteotomy by posterior approach is a valuable tool. Rod failures found approximately 1 year from surgery, with 86% located at level of osteotomy and 14% at lumbosacral junction. Possible reasons are increased stress in the rod at this point and relatively deficient bone stock secondary to wide laminectomy. The low rate of rod breakage at lumbosacral junction may be related to adoption of structural interbody graft and stronger iliac screws. Additional biomechanical studies needed to assess the importance of these factors. This was a level IV study.

Current Concepts - Congenital Scoliosis.

Background:Congenital scoliosis is one of the ‘difficult to treat’ scenarios which a spine surgeon has to face. Multiple factors including the age of child at presentation, no definite pattern of deformity and associated anomalies hinder the execution of the ideal treatment plan. All patients of congenital scoliosis need to be investigated in detail. X rays and MRI of spine is usually ordered first. Screening investigations to rule out VACTERL (Visceral, Anorectal, Cardiac, Tracheo-esophageal fistula, Renal and Lung) abnormalities are required. They are cardiac echocardiography and ultrasonography of abdomen and pelvis. CT scan is required to understand the complex deformity and is helpful in surgical planning.Methods:A comprehensive medical literature review was done to understand the current surgical and non surgical treatment options available. An attempt was made to specifically study limitations and advantages of each procedure.Results:The treatment of congenital scoliosis differs with respect to the age of presentation. In adults with curves more than 50 degrees or spinal imbalance the preferred treatment is osteotomy and correction. In children the goals are different and treatment strategy has to be varied according to the age of patient. A single or two level hemivertebra can easily be treated with hemivertebra excision and short segment fusion. However, more than 3 levels or multiple fused ribs and chest wall abnormalities require a guided growth procedure to prevent thoracic insufficiency syndrome. The goal of management in childhood is to allow guided spine growth till the child reaches 10 - 12 years of age, when a definitive fusion can be done. The current research needs to be directed more at the prevention and understanding the etiology of the disease. Till that time, diagnosing the disease early and treating it before the sequels set in, is of paramount importance.Conclusion:The primary aim of treatment of congenital scoliosis is to allow the expansion of chest and abdominal cavity, while keeping the deformity under control. Various methods can be categorized into definitive (hemivertebrectomy) or preventive (guided growth). Casting, Growth rods, Convex Epiphysiodesis are all guided growth measures. The guided growth procedure either ‘corrects the deformity’ or will have to be converted to a final fusion surgery once the child completes the spinal growth which is preferably done around 10 - 12 years of age. Future directions should aim at genetic counselling and early detection.

Hemivertebra Excision—Posterior-Only Approach With 3-Rod Technique

Posterior-only hemivertebra (HV) excision (PHVE) is an effective treatment for isolated hemivertebrae that cause significant local deformity. Multiple balanced hemivertebrae or global structural deformity is probably not appropriate for PHVE. PHVE works well in cervicothoracic, thoracolumbar, lumbar, and lumbosacral locations, with varying degrees of technical difficulty, while midthoracic PHVE seems less effective. Associated segmental kyphotic deformity is most easily treated, whereas segmental lordosis can be problematic with a posterior-only approach. Careful preoperative anatomical assessment and attention to operative detail can accomplish complete segmental correction without injuring or involving adjacent motion segments. Surgeon skillset for this procedure should include pedicle screw placement in small children and manipulation of the dura dural and control of epidural bleeding.

Single Stage Hemivertebra Excision and Correction of Congenital Scoliosis

Introduction Congenital scoliosis isa progressive three-dimensional deformity caused by congenital anomalies of vertebrae that result in an imbalance of the longitudinal growth of the spine. Failure of the vertebral formation if complete will produce hemivertebra with unilateral pedicle Material and Methods The study included 30 patients with thoracic (16)and lumbar (14) hemivertebra. Posterior only hemivertebra resection with correction by short segment fixation was done for all cases. Intr-operative monitoring was used in (11) cases. Results Full correction was achieved in all cases. Temporary neurological deficit occurred in only two cases. Conclusion Because of the development in anesthesia and post-operative care, today posterior hemivertebra resection has become the standard treatment method for the single hemivertebra of the thoracolumbar and lumbar region.

A modified surgical procedure for congenital kyphoscoliosis: selective partial hemivertebrectomy via posterior-only approach

The study aims to assess the correction efficacy of selective partial hemivertebra excision via posterior-only approach for adolescent patients with congenital kyphoscoliosis. A total of 17 cases (10 M/7 F) were enrolled to this study, all of whom were fully segmented hemivertebra. The mean grade of Risser sign was 1.82 ± 1.07. The average time of follow-up was 20.12 ± 6.88 months. Patients were all treated with selective partial hemivertebra excision and instrumentation via posterior-only approach. The maximal coronal Cobb angle, segmental curves, and segmental kyphotic curves are measured before and after operation, and at the latest follow-up. The data was analyzed to evaluate the correction efficacy. There were no postoperative infections and no neurological complications in all patients. The mean size of the segmental curve was 38.65 ± 5.35° before operation and 13.55 ± 1.82° after operation, with a mean correction of 25.10 ± 5.44°, which turned to 16.59 ± 2.14° at latest follow-up. The mean maximal coronal Cobb angle was 42.90 ± 7.96° before operation, 14.68 ± 2.44° after operation, and 17.50 ± 2.64° at the latest follow-up, giving a correction of 65.7%. The correction rate of segmental kyphotic curve was 72.6%, as the mean segmental kyphotic angle was 22.64 ± 6.74° before operation, 6.15 ± 2.50° after operation, and 6.9° at the latest follow-up, with a loss of 6.90 ± 2.68°. For the patients whose congenital kyphoscoliosis are due to hemivertebrae, selective partial hemivertebra excision and instrumentation via posterior-only approach is recommended to those ranging from 9 to 14 years old, with the Risser sign range grades 0-3 and Cobb angles <60°. This individualized treatment can balance the growth on the two sides of the spine and achieve satisfactory therapeutic effect through removing excrescent growth center.

Surgical management of congenital scoliosis

Objective The aim of this study was to assess outcomes and complications in patients surgically treated for congenital scoliosis. Background Congenital scoliosis due to hemivertebra and unsegmented bar is most often progressive and requires surgical treatment. The recommended surgical options include 'in-situ' fusion, convex hemiepiphysiodesis, and hemivertebra excision. Patients and methods This study included 20 patients (six boys and 14 girls). The age at operation was between 4 and 18 years. Two techniques were used: the anterior procedure and the posterior procedure. The anterior procedure involves thoracotomy and the thoracoabdominal approach. In this procedure disc excision above and below the level of the anomaly was performed and the segment of the vertebral column (hemivertebra, segment of unsegmented bar) that would be excised was determined. In the posterior procedure, posterior correction, fixation, decortications, and grafting were performed. Fixation was carried out using claw, sublaminar wires, pedicular screws, and rods. Results 'In-situ' fusion does not address the anomaly directly; it allows a moderate correction rate but is associated with long spinal fusion. Hemivertebral resection directly addresses the spinal anomaly; it produces the best correction results and is a safe procedure to perform. The average angle after posterior correction and fusion of congenital scoliosis was 37.5΀ (range from 15 to 60΀). The percentage of correction was 55% (range from 20 to 90%). The early postoperative correction following the staged combined anterior and posterior correction, and fusion was 60%, ranging from 40 to 80΀. Conclusion The treatment of congenital scoliosis focuses on early diagnosis and appropriate surgical management before the development of large curves. All of the procedures described can be effective and safely performed if correctly selected and performed by an experienced team of surgeons.

Pedicle Screws Can Eliminate the Need for Hemivertebrae Excision in Late Presenting Congenital Scoliosis or Kyphosis

Hemivertebra excision is considered the gold standard to achieve maximal correction of congenital scoliosis while decreasing the number of levels fused. However, hemivertebra excision is technically challenging. In addition, potential complications include spinal cord and nerve root injury as well as CSF leak. Hemivertebra excision is not required in the surgical treatment of congenital scoliosis in patients presenting late. Our technique allows for similar curve correction and comparable length of fusion, eliminates the need for bracing and decreases risk of neurologic injury.

Convex Short Segment Instrumentation and Hemi-Chevron Osteotomies for Putti Type 1 Thoracic Hemivertebrae

A case series depicting the results of a novel surgical technique. To prove that a minimally invasive surgical technique can effectively control and even correct congenital scoliosis caused by a fully segmented hemivertebra. Congenital hemivertebrae have been treated by anterior and posterior growth arrest with/without fusion, anterior and posterior hemivertebrectomy, transpedicular hemivertebra excision, and transpedicular hemiepiphysiodesis. These approaches are complex and require experience. There is a need for a simple treatment method to treat these deformities. Twelve patients under 5 years of age with Putti type1 hemivertebrae were treated by posterior convex short segment instrumentation, partial chevron osteotomies, and fusion. Scoliosis, segmental scoliosis, kyphosis, segmental kyphosis, trunk shift were measured both preoperatively and postoperatively. The mean correction of the segmental curve was 6 degrees (21%) which was maintained at the latest follow-up. The average final correction of the main curve was 23%. The trunk shift was 1.8 cm (range, 1-3 cm) preoperative and 1.4 cm (range, 0-2.5 cm) at the latest follow-up. The segmental angle of kyphosis averaged 11 degrees (range, -12 to 20 degrees) preoperative, and 14 degrees (range, 0-29 degrees) at the latest follow-up assessment. The values of the total thoracic kyphosis (T2-T12) were 29.5 degrees (range, 10-46 degrees) preoperative, 31 degrees (range, 10-44 degrees) postoperative, and 32 degrees (range, 16-45 degrees) at the last follow-up resulting in a mean improvement of 2 degrees. This improvement continued at the latest follow-up with a mean increase of 3 degrees. Transpedicular instrumentation is ideal for early correction in young children. The new posterior approach is much less invasive than the combined approaches or other posterior vertebrectomies and is well tolerated even in very young patients. The fusion segment is kept short. The deformities seem to stop progressing and this can avoid development of severe local deformities and secondary curves.

Hemivertebra Excision for Congenital Scoliosis

Hemivertebrae result from a failure of complete formation of the vertebral body and present as a challenging clinical entity. Progression and ultimate curve magnitude is associated with the degree of segmentation. An accurate assessment and a close follow-up are necessary to make appropriate treatment decisions. The goal of any intervention is to stop progression and provide the smallest degree of deformity at skeletal maturity. If a high degree of deformity is anticipated, intervention should be attempted sooner rather than later. In these cases, an in situ fusion may be appropriate. Single-stage hemivertebra excision is an effective method of both correction and stabilization; however, the procedure is technically demanding.

Current State of Pedicle Screw Constructs in Children with Spinal Deformity

Pedicle screw use in children is a balance of safety and efficacy. Regardless of patient age or technique, pedicle screws provide 3-column fixation, load sharing surgical correction, long-term fixation, and continued growth for growing constructs. Pedicle screws are essential for 3-column fixation associated with vertebral column resection, hemivertebra excision, or fracture fixation. For nonfusion techniques, pedicle screws are excellent foundations at ends of implant constructs. The unique needs of young children for nonfusion techniques, such as traditional growing rods, Shilla, and staples, with associated regulatory challenges have led to off-label use of adult devices.

L5 Hemivertebra Resection and T12-S1 Fusion in a 14-Year-Old Female With a 36-Year Follow-up

Case report. To demonstrate a 36-year follow-up of a rare operation. There have been no reports of follow-up of pediatric hemivertebra excision and fusion into midadult life. A chart and radiological review at 36 years after surgery. The patient is alive and well and leading a normal life. Her Oswestry Disability Index is 0. Mild degenerative radiological signs are evident at the adjacent level above (T10-T12) and below (sacroiliac joints). Early excision of the L5 hemivertebra would have been preferable, but the long-term results are good.

Efficacy of Hemivertebra Resection for Congenital Scoliosis

Multicenter, retrospective study. To compare the outcomes of three surgical treatments for congenital spinal deformity due to a hemivertebra. Congenital anomalies of the spine can cause significant and progressive scoliosis and kyphosis. Their management may be challenging and controversy remains over the "best" surgical treatment. A multicenter retrospective study of patients with congenital spinal deformity due to 1 or 2 level hemivertebra(e) was performed. The surgical treatments included hemiepiphysiodesis or in situ fusion (group 1), instrumented fusion without hemivertebra excision (group 2), or instrumented hemivertebra excision (group 3). Seventy-six patients with minimum 2-year follow-up were evaluated. The mean age was 8 years (range: 1-18). The hemivertebra were fully segmented, nonincarcerated (67%), incarcerated (1%), and semisegmented (32%). There were 65 patients with single hemivertebra and 11 patients with double hemivertebra. There were 14 (18.4%) group 1, 20 (26.3%) group 2, and 42 (55.3%) group 3 patients. Group 1 (37 ± 14°) and group 3 (35 ± 26°) patients had smaller preoperative curves than group 2 patients (55 ± 26°) (P < 0.01). Group 3 had better percent correction at 2 years than groups 1 and 2 (P < 0.001). Group 3 had shorter fusion (P = 0.001), less estimated blood loss (EBL, P = 0.03), and a trend toward shorter operative times than group 2 (P = 0.10). The overall complication rate for the entire group was 30% group 1 (23%), group 2 (17%), and group 3 (44%) (P = 0.09). While hemivertebra resection for congenital scoliosis had a higher complication rate than either hemiepiphysiodesis/in situ fusion or instrumentated fusion without resection, posterior hemivertebra resection in younger patients resulted in better percent correction than the other two techniques.

Hemivertebra Resection for Congenital Scoliosis in Young Children

A retrospective comparative study of prospectively collected data. To compare clinical, radiographic, and health-related quality of life (Scoliosis Research Society [SRS]-24) outcomes in patients undergoing hemivertebra excision by simultaneous anteroposterior (AP) or posterolateral only approach (PL). AP hemivertebra resection for congenital scoliosis has provided reliable and safe long-term outcomes with respect to clinical and radiographic findings. Recently, PL excision has been described with rather high implant failure and revision rates. There are no studies comparing outcomes of AP and PL hemivertebra excision in 1 center. In addition, studies reporting health-related quality of life after surgery for congenital scoliosis are few. Between 2001 and 2008, 12 AP and 11 PL hemivertebra excisions were conducted in 21 patients (16 males) with congenital scoliosis or kyphoscoliosis due to unbalanced hemivertebrae in our hospital. The average age at surgery was 4.0 years (range, 1.2-11.4) and the mean follow-up time 2.5 years (range, 1-7 years). Before surgery, the mean Cobb angle of the main curve was 33° (range, 25°-45°) in the AP group and 43° (range, 26°-87°) in the PL group. At the final follow-up visit, the main curve had been corrected to a mean of 12° (range, 2°-27°) and 15° (range, 6°-28°), respectively (P = NS). The Scoliosis Research Society-24 total scores were similar, 101 (range, 89-109) for the AP and 100 (range, 85-106) for the PL group at the final follow-up visit. Any complication was observed in 8% (1/12) of patients in the AP group and, whereas the PL group had 40% (4/10) complication rate with 2 temporary neurologic deficits, no implant failures were observed. All patients underwent spinal fusion during follow-up. PL resection is technically more demanding and slightly faster method for hemivertebral resection. It has nearly as good correction rate as the AP-method but more minor complications. Hemivertebrectomy seems to provide a controllable untethering effect in patients with a symptomatic tethered cord.

Hemivertebra excision with short-segment spinal fusion through combined anterior and posterior approaches for congenital spinal deformities in children

To evaluate the therapeutic results of hemivertebra excision through combined anterior and posterior approach followed by short-segment spinal fusion with transpedicular instrumentation in children. Clinical and radiological evaluations were conducted before and after operation and at the follow-up examination. Cobb angles of segmental curve, total main curve, compensatory curves (cranial and cauda) and kyphosis were recorded. All the cases showed satisfactory results, the mean Cobb angle of segment curve was 45.3° before surgery and 14.9° after surgery with 67.1% correction, and 13.5° at the final follow-up assessment with 70.2% correction. Total main curves improved from 47.6 to 18.2° with 61.8% correction, and 16.0° at the final follow-up. Cranial and caudal compensatory curves were improved gradually during follow-up. Kyphosis of the spine also improved obviously. If the operation was performed before the maturity of bone, the secondary spinal deformities could be effectively avoided.