Abstract
Purpose
Until now there have been many reports on hemivertebra resection. But there were no large series on the posterior hemivertebra resection with bisegmental fusion. This is a retrospective study to evaluate the surgical outcomes of posterior hemivertebra resection only with bisegmental fusion for congenital scoliosis caused by fully segmented non-incarcerated hemivertebra.
Methods
In our study, 36 consecutive cases (19 males, 17 females) diagnosed with congenital scoliosis, resulting from fully segmented non-incarcerated hemivertebra, treated by posterior hemivertebra resection with bisegmental fusion were investigated retrospectively, with at least a 3 year follow-up period (36–106 months).
Results
The total number of resected hemivertebra was 36. Mean operation time was 188.6 min with average blood loss of 364.2 ml. The segmental scoliosis was corrected from 36.6° to 5.1° with a correction rate of 86.1 %, and segmental kyphosis(difference to normal segmental alignment) from 21.2° to 5.8° at the latest follow-up. The correction rate of the compensatory cranial and caudal curve is 76.4 and 75.1 %. Unanticipated surgeries were performed on eight patients, including one delayed wound healing, two pedicle fractures, one progressive deformity and four implants removals.
Conclusions
Posterior hemivertebra resection with bisegmental fusion allows for early intervention in very young children. Excellent correction can be obtained while the growth potential of the unaffected spine could be preserved well. However, it is not indicated for the hemivertebra between L5 and S1. The most common complication of this procedure is implant failure. Furthermore, in the very young children we noted that although solid fusion could be observed in the fusion level, implants migration may still happen during the time of adolescence, when the height of the body developed rapidly. So a close follow-up is necessary.
Similar content being viewed by others
References
McMaster MJ, Ohtsuka K (1982) The natural history of congenital scoliosis: a study of 251 patients. J Bone Joint Surg[AM] 64A:1128
Winter RB, Moe JH, Eilers VE (1968) Congenital scoliosis: a study of 234 patients treated and untreated. J Bone Joint Surg 50A:1
Bollini G, Docquier PL, Viehweger E et al (2006) Lumbar hemivertebra resection. J Bone Joint Surg [Am] 88:1043–1052
Bollini G, Docquier PL, Viehweger E et al (2006) Thoracolumbar hemivertabra resection by double approach in a single procedure: long-term follow-up. Spine 31:1745–1757
Bradford DS, Boachie-Adjei O (1990) One-stage anterior and posterior hemivertebral resection and arthrodesis for congenital scoliosis. J Bone Joint Surg [Am] 72(4):536–540
Hedequist DJ, Hall JE, Emans JB (2005) Hemivertebra excision in children via simultaneous anterior and posterior exposures. J Pediatr Orthop 25:60–63
Hedequist DJ, Hall JE, Emans JB (2004) The safety and efficacy of spinal instrumentation in children with congenital spine deformities. Spine 29:2081–2086 discussion 2087
Holte DC, Winter RB, Lonstein JE et al (1995) Excision of hemivertabra and wedge resection in the treatment of congenital scoliosis. J Bone Joint Surg [Am] 77:159–171
King KD, Lowery GL (1991) Results of lumbar hemivertebral excision for congenital scoliosis. Spine 18:778–782
Lazar RD, Hall JE (1999) Simultaneous anterior and posterior hemivertebra excision. Clin Orthop Relat Res (364):76–84
Leatherman KD, Dickson RA (1979) Two-stage corrective surgery for congenital deformities of the spine. J Bone Joint Surg [Br] 61:324–328
Bergoin M, Bollini G, Taibi L et al (1986) Excision of hemivertabra in children with congental scoliosis. Ital J Orthop Traumatol 12:179–184
Shono Y, Abumi K, Kaneda K (2001) One-stage posterior hemivertebra resection and correction using segmental posterior instrumentation. Spine 26:752–757
Ruf M, Harms J (2002) Hemivertebra resection by a posterior approach: innovative operative technique and first results. Spine 27:1116–1123
Ruf M, Harms J (2002) Pedicle screws in 1- and 2-year-old children: technique, complications, and effect on further growth. Spine 27:E460–E466
Ruf M, Harms J (2003) Posterior hemivertebra resection with transpedicular instrumentation: early correction in children aged 1–6 years. Spine 28:2132–2138
Nakamura H, Matsuda H, Konishi S et al (2002) Single-stage excision of hemivertabra via the posterior approach alone for congenital spine deformity: follow-up period longer than 10 years. Spine 27:110–115
Smith JT, Gollogly S, Dunn HK (2005) Simultaneous anterior-posterior approach through a stotransversectomy for the treatment of congenital kyphosis and acquired kyphoscoliotic deformities. J Bone Joint Surg [Am] 87:2281–2289
Ruf M, Jensen R, Letko L et al (2009) Hemivertebra resection and osteotomies in congenital spine deformity. Spine 34:1791–1799
Yaszay B, O'Brien M, Shufflebarger HL et al (2011) Efficacy of hemivertebra resection for congenital scoliosis: a multicenter retrospective comparison of three surgical techniques. Spine 24:2052–2060
Polly DW Jr, Rosner MK, Monacci W et al (2003) Thoracic hemivertebra excision in adults via a posterior-only approach: report of two cases. Neurosurg Focus 14(2):9–11
Papp T, Porter RW, Aspden RM (1994) The growth of the lumbar vertebral canal. Spine 19:2770–2773
Porter RW, Pavitt D (1987) The vertebral canal: I. Nutrition and development, an archaeological study. Spine 12:901–906
Zindrick MR, Knight GW, Sartori MJ et al (2000) Pedicle morphology of the immature thoracolumbar spine. Spine 25:2726–2735
Zhang JG, Wang SR, Qiu GX et al (2011) The efficacy and complications of posterior hemivertebra resection. Eur Spine J 20:1692–1702
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Wang, S., Zhang, J., Qiu, G. et al. Posterior hemivertebra resection with bisegmental fusion for congenital scoliosis: more than 3 year outcomes and analysis of unanticipated surgeries. Eur Spine J 22, 387–393 (2013). https://doi.org/10.1007/s00586-012-2577-4
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-012-2577-4