Hemivertebra Resection and Spinal Arthrodesis by Single-Stage Posterior Approach in Congenital Scoliosis and Kyphoscoliosis: Results at 9.6 Years Mean Follow-up

Abstract

Background: Congenital kyphoscoliosis due to hemivertebra is generally treated surgically because of high risk of curve progression and high risk of nervous system complications. Modern posterior access surgical techniques, including total hemivertebra resection, can completely correct deformity without additional anterior access surgeries. The purpose of this study was to evaluate midterm results of hemivertebra resection and spinal arthrodesis; the hypothesis was that it is a safe, effective, and reproducible procedure.Materials and Methods: From 2006 to 2019, hemivertebra resection and instrumented spinal arthrodesis with pedicle screws was performed on 82 patients with congenital vertebral deformities (62 scoliosis and 20 kyphoscoliosis) by posterior approach. Mean age at surgery was 8.6 years, and 22 patients were under 10 years of age. After stabilization patients have been braced for a period from 3 to 5 months.Results: Mean follow-up was 9.6 years (range 1.2-12.8 years); mean kyphosis curve after surgery was reduced to 20° Cobb; and mean scoliosis curve was reduced to 11° Cobb. We experienced no major complications (postsurgical infection, instrumentation failure, severe neurological impairment, severe blood loss) at latest follow-up .Conclusion: We strongly advocate one-time posterior hemivertebra resection and arthrodesis as the most suitable surgical procedure for congenital scoliosis due to hemivertebra. Posterior approach interventions with pedicle screws instrumentation are less invasive than combined anterior-posterior approach interventions. We think that posterior approach procedures can lead to excellent deformity correction in both frontal and sagittal views, optimal stability, and low risk of nervous injury.Clinical Relevance: Congenital scoliosis treatment is one of the most challeging conditions a spine surgeon has to face. We advocate that a one-stage posterior approach for hemivertebrectomy and fusion is a reliable, safe tachnique, whom excellent results remain stable at a mid/long-term follow-up.

Effects of one-stage posterior hemivertebrectomy for hemivertebral imbalance on spinal imbalance and shoulder balance: A retrospective study

“…Our results demonstrated that the correction rates of the sagittal Cobb angle and total main Cobb angle at the last follow-up were 60.61% (53.71-70.29%) and 64.08 (57.97-71.76%), respectively, which were similar to the previously reported results of HV resection [17,22,23]. In addition, compared with preoperative, the correction rates of the SK angle at the last follow-up 56.80% (42.98-63.70%).…”

Congenital kyphoscoliosis associated with thoracic hemivertebrae in a 9‐month‐old Racking filly

“…In humans, early diagnosis, conservative treatment and corrective surgical techniques including hemivertebra resection are recommended before developing neurological signs or severe deformity and disability in cases with scoliosis and kyphoscoliosis (Crostelli et al, 2022; Han et al, 2011; Oksanen et al, 2021; Ruf et al, 2006; Xia et al, 2022; Yang et al, 2020). Still, there is no treatment for this condition in horses (Fürst, 2018).…”

Prognosis of Natural Course for Spinal Deformity in Pediatric Patients With Thoracic Hemivertebrae (Preliminary Results)

“…Основополагающими исследованиями являются работы Robert Winter с соавторами от 1968 года [6] и Michael McMaster и K. Ohtsuka от 1982 года [7]. С учетом основополагающих принципов раннего начала хирургического лечения детей с врожденными пороками развития позвоночника более поздние исследования посвящены, в основном, оценке результатов лечения [8,9] и выбору оптимальных методик оперативного вмешательства [10,11]. Несмотря на данные принципы, результаты хирургического лечения отражают как хорошие исходы, так и неблагоприятные, к которым относится появление диспластических деформаций позвоночника после выполненного оперативного вмешательства у детей с врожденными пороками развития позвонков [12].…”