Surgical Treatment Of Congenital Scoliosis Research Articles

Surgical treatment of congenital scoliosis

Early correction of congenital scoliosis including short fusion, while minimizing both mobility restrictions and growth impairment. Congenital scoliosis with marked deformity, proven progression, significant compensatory curves, and/or impairment of trunk balance. Furthermore, in case of compression of neural structures or pain due to secondary degeneration. No absolute contraindication. Posterior approach to the apex of the deformity. In the growing spine the periosteum should only be touched at the levels where fusion is planned. Insertion of pedicle screws adjacent to the hemivertebra. The posterior elements of the hemivertebra are removed: lamina, joint facets, pedicle, transverse process. Resection of the accessory proximal rib in the thoracic spine. Following blunt dissection at the lateral and anterior surface of the hemivertebra, the body of the hemivertebra and the adjacent discs are resected. The resulting gap is closed by compression via transpedicular instrumentation thus correcting the scoliotic deformity. In case of synostosis or contralateral bar formation, the concave side of the spine is dissected and the synostosis osteomized. Early mobilization on postoperative day1. Bracing for 12weeks depending on stability of the instrumentation. Periodic clinical and radiographic controls until the end of growth. Posterior hemivertebra resection with transpedicular instrumentation is considered as the standard treatment of congenital scoliosis. Correction rates of 60-80% are achieved. Cervical and lumbosacral hemivertebrae may require an additional anterior approach. In case of synostosis, bar formation, or rib synostosis, further corrective surgeries may be necessary during growth.

Ten-year trends in surgical management of 1207 congenital scoliosis.

To report and analyze development trends in the surgical treatment of congenital scoliosis (CS) in a large CS cohort over a 10-year period. We retrospectively searched and extracted medical records of CS inpatients receiving posterior instrumented fusion surgery at our institute from January 2010 to December 2019. We analyzed information on demographics and surgical information, including the surgical approach, number of fused segments, use of osteotomy and titanium cage implantation, length of stay, intraoperative blood loss, and rates of complications and readmission. 1207 CS inpatients were included. In the past decade, the proportion of patients younger than 5years increased from 15.5 to 26.9%. The average number of fused segments decreased from 9.24 to 7.48, and the proportion of patients treated with short-segment fusion increased from 13.4 to 30.3%. The proportion of patients treated with osteotomy and titanium cage implantation increased from 55.65% and 12.03% to 76.5% and 40.22%. The average length of stay and blood loss decreased from 16.5days and 816.1ml to 13.5days and 501.7ml. The complication and readmission rates also decreased during these ten years. During this ten-year period, the surgical treatment of CS at our institute showed trends toward a younger age at fusion, lower number of fused segments, higher rate of osteotomy and titanium cage implantation, reduced blood loss, shorter length of stay and lower rate complications and readmission. These results suggest performing osteotomy combined with titanium cage implantation at an earlier age can achieve fewer fused segments and complications.

Posterior Instrumentation and Fusion in Multiple-segment Adolescent Congenital Scoliosis: When Are Posterior Column and Concave Rib Osteotomies Needed?

No clear guidelines exist for appropriate surgical treatment of congenital scoliosis. The spectrum varies from isolated posterior instrumentation and fusion (PIF-only) to vertebral column resections. Multiple posterior column osteotomies (PCOs) with and without concave rib osteotomies have previously been suggested as an alternative to invasive 3-column osteotomies. The aim of the study is to analyze outcomes of spinal surgery in congenital scoliosis patients for a new treatment algorithm based on a traction radiograph under general anesthesia (TruGA). Surgical intervention was determined according to flexibility with TruGA: patients with >40% correction underwent PIF-only; patients with <40% of correction underwent PCO. Patients, who had <30% of correction in TruGA and/or more than 5 vertebral levels with failure of segmentation, underwent additional concave rib osteotomies. The radiologic and clinical results were compared. Forty-three patients met inclusion criteria (14M). The mean age was 13.8 (10 to 17) years, average follow-up 67 (24 to 107) months. Fourteen patients were in the PIF-only group, 29 in the PCO group. PCO patients were significantly older (14.5 vs. 12.3, P=0.001). Mean operative time and blood loss of PCO group were significantly greater than those of PIF-only group. Nine patients required concave rib osteotomies. While the curve magnitude of patients in the PIF-only and PCO groups did not differ significantly (54.6 vs. 63 degrees, P=0.067), curve rigidity was significantly higher in the patients of PCO group (51.2% vs. 32%, P=0.001). Despite this, postoperative correction rates for 2 groups were similar (51.1% vs. 47.8%, P=0.545). The number of anomalous segments and the curve flexibility on TruGA play important roles in the decision-making process in congenital scoliosis and <40% flexibility of the major curve could be an important indicator of the need for PCO. Curves with more than 5 anomalous vertebral segments might be more likely to need additional concave rib osteotomies for adequate correction. Level III.

Three-Dimensional Printing Technology for Surgical Correction of Congenital Scoliosis Caused by Hemivertebrae

This study aimed to explore the clinical application of three-dimensional (3D) printing technology in the surgical treatment of congenital scoliosis caused by hemivertebrae. Twenty-four patients (11 in the 3D-printing group and 13 in the conventional group) with scoliosis secondary to a single hemivertebra were retrospectively reviewed. All patients underwent hemivertebrectomy and short-segment fixation. Virtual preoperative planning, operation simulation, and intraoperative application of 3D-printed patient-specific templates were performed in the 3D-printing group. Hemorrhage volume, operation time, transfusion, and complications were noted. Radiographic parameters were evaluated preoperatively, postoperatively, and at final follow-up. All patients had different degrees of successfully corrected scoliosis. There was a similar correction of the Cobb angle postoperatively between the 2 groups. The operation time, blood loss, transfusion, time for the insertion of each screw, accuracy of screw placement, and complication rate in the 3D-printing group were significantly superior to those in the control group. No patient experienced major complications. No significant correction loss or instrument dysfunction was observed during follow-up. As a viable and effective auxiliary technology, 3D printing makes it possible for surgery to meet both surgeon-specific and patient-specific requirements. 3D-printed individualized templates allow surgery for the correction of congenital scoliosis to enter a new stage of personalized precision surgery.

Clinical and radiological outcomes of hemivertebra resection for congenital scoliosis in children under age 10 years: More than 5-year follow-up.

The surgical treatment of congenital scoliosis under 10 years is difficult as it involves resecting vertebrae. Moreover, patient follow-up after surgery is extremely important because the patient is a child whose growth has not been completed. However, there are very few long-term follow-up studies after surgical treatment of congenital scoliosis. Therefore, this study is designed to evaluate surgical outcomes after posterior hemivertebra resection in children under 10 years and its long-term effects.Twenty-one patients with congenital scoliosis who were younger than 10 years at the time of the surgery and received posterior hemivertebra resection and fusion using pedicle screw fixation were included in this study.There were significant improvements in the main curve, coronal balance, sagittal vertical axis, thoracic kyphosis, and lumbar lordosis after surgery (P < .001, .021, .047, .043, .006, respectively). Coronal balance, sagittal vertical axis, thoracic kyphosis, and lumbar lordosis remained within the normal range during the follow-up period; however, main curve deteriorated significantly (P = .005). Trunk appearance of perception scale improved significantly after surgery (P = .031) and was maintained during the follow-up period (P = .078).In conclusion, posterior hemivertebra resection and fusion using pedicle screw fixation in patients under 10 years old with congenital scoliosis is a safe and effective procedure that can achieve rigid fixation and deformity correction. Complete resection of the hemivertebra is important for deformity correction and prevention of curve progression, and careful long-term follow-up is necessary.

Tips and tricks to obtain good results in the surgical treatment of congenital scoliosis by posterior hemivertebra resection and segmental spinal fusion

Fully segmented hemivertebra represents one of the most frequent cause of congenital scoliosis. This spinal malformation requires in many cases surgery and nowadays the golden standard is represented by posterior hemivertebra resection and segmental posterior fusion. The technique is a demanding one, but with proper preoperative planning and careful surgery, it ensures good results. Some tips and tricks are useful to avoid poor results and re-interventions.

Tips And Tricks to Obtain Good Results in the Surgical Treatment of Congenital Scoliosis By Posterior Hemivertebra Resection and Segmental Spinal Fusion

Tips And Tricks to Obtain Good Results in the Surgical Treatment of Congenital Scoliosis By Posterior Hemivertebra Resection and Segmental Spinal Fusion

Combined 3D rapid prototyping and computer navigation facilitate surgical treatment of congenital scoliosis

Rationale:This study describes the technique of combined Orbic 3D navigation (O3DN) and 3D rapid prototyping (3DRP) to assist surgical correction of congenital scoliosis.Patient concerns:A 12-year-old boy with congenital scoliosis. His father brought him to our hospital upon noticing the boy's asymmetry of the trunk.Diagnoses:Congenital scoliosis.Interventions:O3DN and 3DRP were used to assist correction surgery in this patient.Outcomes:The Cobb angle of segmental scoliosis (T8-L2) was 46.9° preoperatively and 2.3° at the last postoperative follow-up; correction was 95.1%. The average segmental kyphosis (T5-T12) was 45.2° preoperatively and 18.6° at the postoperative follow-up; correction was 58.9%. The preoperative sagittal imbalance of 56.2 mm was improved to 9.7 mm. The mean distance between the center sacral vertical line and the C7 plumb line was reduced from 5.7 to 4.1 mm. Operative time and bleeding volume was impressively little, with no misplacement of pedicle screws or other surgical complications.Lessons:Combined 3DRP and O3DN helped achieve satisfactory correction for this case of congenital scoliosis. The application of 3DRP aided by O3DN in surgical treatment of congenital scoliosis can reduce operative time, lessen blood loss, reduce screw misplacement, and avoid neurovascular damage. However, patients’ hospital costs were greater. Our lessons learnt are that the relative position between the tracker and the pedicle must be static to ensure the accuracy of the whole system during the entire operation.

Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters: P82. Surgical strategy for congenital scoliosis associated with asymptomatic tethered cord

BACKGROUND CONTEXT A few studies in surgical treatment of congenital scoliosis have been associated with asymptomatic tethered cord. PURPOSE To evaluate the safety and effectiveness of correction of congenital scoliosis associated with asymptomatic tethered cord without untethering it. STUDY DESIGN/SETTING A case series. PATIENT SAMPLE Twenty-six patients. OUTCOME MEASURES Cobb angle of major coronal and kyphotic curve. METHODS Twenty-six patients with asymptomatic tethered cord who underwent congenital scoliosis correction were presented. There were 17 male and 9 female with an average 15.2years (range 13–22). RESULTS The preoperative Cobb angle of major coronal curve averaged 55° (range 38°–74°), and it measured 21° (range 13°–35°) at the last follow-up, for a 62% correction. Maximal kyphosis averaged 43° (range 32°–54°) preoperatively, and improved to 23° (range 16°–38°) at ultimate follow-up, for a 46% correction. The average follow-up was 6.5years (4–8 years). None of the patients experienced deterioration in their neurologic status. CONCLUSIONS The study results suggested that prophylactic neurosurgery may be unnecessary in patients with asymptomatic tethered cord who underwent congenital scoliosis correction. One-stage posterior correction of scoliosis in this patient population does not involve significant complications and seems to be an alternative and safe treatment option.

Surgical Treatment of Congenital Scoliosis Associated With Tethered Cord by Thoracic Spine-shortening Osteotomy Without Cord Detethering.

Retrospective case series. To investigate the safety and efficacy of spine-shortening osteotomy for congenital scoliosis with tethered cord. Conventional surgery for congenital scoliosis associated with tethered cord risks the complications of detethering. Spine-shortening osteotomy holds the potential to correct scoliosis and decrease spinal cord tension simultaneously without an extra detethering procedure, but no data on this issue is available. 21 patients (14 females and 7 males, average age 15.4 yr) underwent spine-shortening osteotomy without detethering. All of the patients had tethered cord. Patients with main curve more than 90° underwent vertebral column resection (VCR), whereas the others had pedicle subtraction osteotomy (PSO) performed. The average postoperative follow-up period was 45.2 months. The mean operation time was 544.5 min with average blood loss of 2769.1 ml. The deformity correction was 61.3% in the coronal plane and 43.9° in the sagittal plane. 10 patients had neurological deficits preoperatively. At the final follow-up, the deficits in 8 (80%) patients were significantly improved, whereas 2 (20%) remained unchanged. At final follow-up, 71.4% (5/7) patients reported improvement in motor function, 100% (3/3) had improved pain scores, and 75% (3/4) reported better sensory function after the spine-shortening osteotomy. Urinary dysfunction and bowel incontinence present preoperatively in 3 patients all recovered by final follow-up. 5 (23.8%) patients incurred complications including temporary neurological deterioration in 1 patient, urinary tract infection in 2 patients, cerebrospinal fluid leakage in 1 patient, and blood loss more than 5000 ml in 1 patient. Spine-shortening osteotomy is a safe and effective procedure for congenital scoliosis associated with tethered cord. Spine-shortening osteotomy at the thoracic apical vertebrae level not only corrects the spine deformity but also simultaneously releases the tension of the tethered cord, resulting in improved neurologic function.

A comparison of the effects of two different techniques on shoulder balance in the treatment of congenital scoliosis: Vertical expandable prosthetic titanium rib and dual growing rod.

Purpose:The purpose of this study is to compare the effects of two different growth guidance techniques (dual growing rod and vertical expandable prosthetic titanium rib [VEPTR]) on shoulder balance, in the surgical treatment of congenital scoliosis.Materials and Methods:Thirteen patients who were operated due to congenital scoliosis are divided into two groups. The coracoid height difference and clavicular tilt angle difference were measured on standing anteroposterior X-ray images in the preoperative, early postoperative periods, and during the last follow-up.Results:Clinical improvement in shoulder balance was obtained in VEPTR during the last follow-up, but there was no significance in the comparison among the two groups during the last follow-up.Conclusion:The effect of the growth guidance techniques on shoulder balance positively contributes in the surgical treatment of congenital scoliosis.

Split Spinal Cord Malformation: Report of 5 Cases in a Single Chinese Center and Review of the Literature

Background: Split spinal cord malformation (SSCM) is rare in scoliosis. This study evaluated the safety and effectiveness of one-stage surgical treatment of congenital scoliosis (CS) in patients with SSCM in a single Chinese center. Method: A retrospective study of 5 cases who underwent surgery for CS with SSCM (2 type I and 3 type II) from March 2004 to March 2012. Patients included 4 females and 1 male with a mean age of 13.8 years. All patients underwent one-stage posterior fusion surgery with resection of a bony spur firstly in SSCM type I, but we did nothing to the SSCM in type II. Clinical symptoms and radiological changes were evaluated preoperatively and for at least 2 years postoperatively. Results: Preoperatively, 5 patients had variant neurological and other symptoms. They had a mean preoperative Cobb angle of 63 ± 20° and T5-T12 kyphosis of 30 ± 21°. The mean postoperative Cobb angle was 30.2 ± 19.8° with a correction rate of 57.2 ± 17.0%. At the 3-month follow-up the Cobb angle loss was 3.0 ± 6.8°, and at the 2-year follow-up the Cobb angle loss was 6.5 ± 9.7°. Hyperkyphosis was significantly corrected after surgery but correction loss was indicated at the 2-year follow-up (p < 0.01). There were no neurological deficit complications or deteriorated neurological signs postoperatively or at follow-up. Conclusions: One-stage surgical treatment of CS with SSCM could be safe and effective, but we need further multicenter studies with larger samples. Intraspinal intervention of bone spur was recommended in SSCM type I before deformity correction, while in SSCM type II it was needless.

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.

A “simple” option in the surgical treatment of congenital scoliosis

Commentary on: Li X-F, Liu Z-D, Hu G-Y, et al. Posterior unilateral pedicle subtraction osteotomy of hemivertebra for correction of the adolescent congenital spinal deformity. Spine J 2011;11:111-118 (in this issue).

Surgical treatment of congenital scoliosis resulting from an isolated hemivertebra: 27 cases

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 noncomparative 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 mean Cobb 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. Thoracic vertebral epiphysiodesis required prior excision at two levels, followed by a subsequent 4-level decortication phase: in 6 cases the vertebrae 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.

Surgical treatment of congenital scoliosis

Surgical treatment of congenital scoliosis

Lumbar Wedge Resection Osteotomy for Congenital Scoliosis due to a Sacral Malformation - A Case Report -

Congenital scoliosis due to a sacral malformation is quite rare. To the best of our knowledge, most wedge resection osteotomies have been performed to correct a kyphotic deformity in ankylosing spondylitis. However, there is no report of a trapezoidal lumbar wedge resection osteotomy of the vertebral body in the surgical treatment of congenital scoliosis due to a sacral malformation. This paper reports a 41-year-old female with a 25-year history of lower back and buttock pain combined with radiating pain to the lower extremities. The coronal imbalance was 3.8 cm and the scoliosis angle using the Cobb method was 22˚. A trapezoidal wedge resection osteotomy of the L5 body was performed, and the scoliosis was corrected. We detail this modification of a vertebral osteotomy technique and show that a fixed coronal deformity could be corrected effectively using this technique.

Evaluation and treatment of congenital scoliosis with split cord malformation

To discuss the diagnosis and surgical treatment of congenital scoliosis (CS) with split cord malformation (SCM). From May 1999 to June 2004, 353 cases of CS were admitted, and 58 cases were diagnosed CS combined with SCM via myelography and (or) CTM. According to Pang's classification for SCM, patients were divided into type I SCM and type II SCM. Two cases gave up operation, and surgeries were performed in 56 patients. Except that one case with arachnoid cyst underwent intraspinal exploration, all other 55 cases underwent spinal correction without dealing with the intraspinal abnormalities. Clinical manifestation, radiological findings, operative methods and results were retrospectively analyzed in this paper. There were 11 patients (19%) with type I SCM and 47 patients (81%) with type II SCM. In the 56 cases who had surgical treatment, the Cobb angle in the patients with type I SCM (11 cases) was (60 +/- 25) degrees, and in type II SCM (45 cases) was (67 +/- 21) degrees pre-operation. The Cobb angle in type I SCM was (29 +/- 13) degrees and in type II SCM was (39 +/- 19) degrees post-operation, with the correction rate (51 +/- 17)% and (41 +/- 24)% respectively. No statistic differences were found between both types. And there were no new neurological deficits in both groups after the spinal correction operation. After average 17.3 months (4-59 months) follow-up, the correction loss was (6 +/- 10) degrees, (5 +/- 8) degrees in 7 patients with type I SCM and (6 +/- 10) degrees in 19 patients with type II SCM. There was no statistic difference in correction loss between both types. In the follow-up, the neurological symptoms and signs of the patients were stable. Considering the incidence of intraspinal anomalies in patients with congenital scoliosis, intraspinal examination via myelography, CTM or MRI should be performed prior to spinal correction surgery. For congenital scoliosis with type I SCM, the bone spur need not be excised before spinal correction if there is no signs of spinal cord tethered and the bone spur locate in the middle of the split cord where there are much space to accommodate it. For congenital scoliosis with type II SCM, if there are no progressive neurological manifestations, the split cord in the single tubular can tolerate the manipulation of spinal correction as the normal spinal cord.

Evaluation of Kidney Anomalies in Congenital Scoliosis

Evaluation of Kidney Anomalies in Congenital Scoliosis

Surgical treatment of congenital scoliosis with or without harrington instrumentation: J. E. Hall, W. A. Herndon, and C. R. Levine. J. Bone Joint Surg 63A:608–618, (April), 1981

Surgical treatment of congenital scoliosis with or without harrington instrumentation: J. E. Hall, W. A. Herndon, and C. R. Levine. J. Bone Joint Surg 63A:608–618, (April), 1981