Hemivertebra Resection With Instrumented Fusion by Posterior Approach in Children

Piantoni, Lucas; Wilson, Ida A. Francheri; Tello, Carlos; Noël, Mariano A.; Galaretto, Eduardo; Remondino, Rodrigo; Bersusky, Ernesto

doi:10.1016/j.jspd.2015.04.008

Cited by 21 publications

(13 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Despite better correction and better final result reached in patients with congenital scoliosis operated of hemivertebra of congenital bar resection, 14,15,17 one should note the nonnegligible rate of complications, especially mechanical ones reported more and more leading to more instrumentation, higher costs, wider fusion, and more surgical reinterventions. 14,15,17 Despite being a census of all operated cases in a single center between 1990 and 2010, the main limitation of this study remains the limited size of the population. However, congenital scoliosis is an uncommon pathology and similar published studies had comparable population size.…”

Section: Discussionmentioning

confidence: 99%

“…4,12,13 Hemivertebra resection followed by posterior fusion seems to be nowadays the treatment of choice permitting immediate correction of the deformity, and a more predictable outcome in the aftermath of this intervention. 4,5,14 However, hemivertebra resection is associated with higher blood loss, longer operative time, and more neurologic incidents and complications. 5,15 Keeping in mind that correction of deformity after hemiepiphysiodesis is a chronic and slowly progressive phenomenon, long-term follow-up is needed before definitive outcome is fixed.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Is There Still a Place for Convex Hemiepiphysiodesis in Congenital Scoliosis in Young Children? A Long-Term Follow-up

Rizkallah

Sebaaly

Kharrat

et al. 2019

Global Spine Journal

View full text Add to dashboard Cite

Study Design: Retrospective cohort. Objectives: To evaluate the long-term effect of convex growth arrest (CGA) on coronal deformity correction in congenital scoliosis. Methods: Twenty-two patients with congenital scoliosis operated by 1-staged double approach hemiephysiodesis by bone grafting of the convex side without instrumentation are included. Eighteen curves had an isolated hemivertebra while 4 curves had congenital bar. Subgroup analysis was performed according to age at surgery (3 years cutoff), type of malformation (hemivertebra vs congenital bar), and severity of curve (35° cutoff). Results: Patients’ mean age at surgery was 3 years (range 0.5-8 years), with a mean frontal Cobb angle of 40.59°. Mean follow-up is 10.7 years (range 5.5-25 years). Overall results showed mean frontal Cobb angle reduction of 35.47% (40.59° to 27.41°). Detailed analysis showed that 15 curves had a mean correction of 51.8%, 5 stabilized and 2 had a mean aggravation of 25.11%. Subgroup analysis revealed that patients operated ≤3 years of age had mean cobb angle correction of 43.1% versus 21.49% in patients operated >3 years ( P = .140). Mean correction of 44.5% was gained in curves with isolated hemivertebra compared with 1.3% in curves with congenital bar ( P = .004). A 58.17% mean correction was reached in curves ≤35° versus 23.68% in curves >35° ( P = .032). Conclusions: A limited convex hemiepiphysiodesis still has a place in congenital scoliosis care when it is performed in patients ≤3 years old, with curves ≤35°, and with isolated hemivertebra. It spares patients the risks of vertebral resection and instrumentation, while fusing the same number of levels.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Is There Still a Place for Convex Hemiepiphysiodesis in Congenital Scoliosis in Young Children? A Long-Term Follow-up

Rizkallah

Sebaaly

Kharrat

et al. 2019

Global Spine Journal

View full text Add to dashboard Cite

show abstract

“…Özellikle tam ayrışmış hemivertebralarda ilerleme potansiyeli yüksek olduğundan erken müdahale önemlidir. Kombine anterior-posterior yaklaşımla uygulanabilse de güncel birçok makale sadece posterior yaklaşımla güvenli, etkili ve daha az invaziv olarak hemivertebrektominin yapılabileceğini göstermiştir (16,(23)(24)(25). Ameliyatta düzeltmenin kolaylaştırılması, implant yetmezliği riskinin azaltılması ve ameliyat sonrası korseleme ihtiyacının azaltılması için supra-ve infra-laminar çengeller ile desteklenen 3-rod tekniği kullanılabilir (26) (Şekil 1).…”

Section: Hemivertebrektomi + Limitli Füzyonunclassified

Konjenital Skolyoz Tanı ve Tedavisi

Yılgör¹,

Eroğlu²,

Söğünmez³

et al. 2020

View full text Add to dashboard Cite

Omurganın en sık görülen konjenital deformitesi konjenital skolyozdur. Deformiteyi oluşturan sebep, oluşum veya ayrışma kusuru veya bu iki bozukluğun birlikte olduğu karma tiptir. Kliniğe yansıması, stabil hemivertebradan, pulmoner, kardiyak, genitoüriner ve nörolojik komplikasyonlara yol açabilen karmaşık ve ilerleyici deformitelere kadar geniş bir aralıktadır. Tabloya sıklıkla diğer organ sistemlerindeki anomaliler eşlik eder. Tanıda; prenatal ultrason, fizik muayene ve röntgen kullanılır. Manyetik rezonans eşlik eden intradural patolojilerin ortaya konulmasında yardımcıdır. Bilgisayarlı tomografi cerrahi planlamada yardımcı olabilir. Tedavi planı eğriliğin yeri ve derecesi, hastanın yaşı, deformitenin tipine ve öngörülen ilerleme beklentisine göre her hastaya özel olarak yapılır. Tedavi temel olarak kontrollü gözlem, konservatif ve cerrahi tedavilerden oluşur. Tek hemivertebra varlığında genellikle erken yaşta hemivertebrektomi ve limitli füzyon önerilir. Daha karmaşık deformitelerde hemiepifizyodez, distraksiyon temelli füzyonsuz cerrahi yöntemler veya bunların kombinasyonları kullanılabilir. Günümüzde teknolojik ilerlemeler sayesinde spinal deformite ve intradural patolojilerin cerrahisi eş zamanlı olarak güvenli şekilde yapılabilmektedir. İhmal edilmiş ileri deformitelerde düzeltici osteotomiler gerekebilir. Düzeltici osteotomiler barındırdıkları nörolojik yaralanma riski ve uygulamadaki teknik zorluklar nedeniyle donanımlı merkezlerde deneyimli cerrahlar tarafından gerçekleştirilmelidir.

show abstract

“…However, hemivertebra excision is the only perpetually corrective therapy 8 . Since the publication of the first hemivertebra resection case by Royle in 1928, it has been proven to be reliable and effective in correcting deformities by several studies 9, 10 . In recent years, the application of posterior hemivertebra excision in children with early‐onset CS has proven to be a safe and effective surgical method 11–13 .…”

Section: Introductionmentioning

confidence: 99%

Individualized Study of Posterior Hemivertebra Excision and Short‐Segment Pedicle Screw Fixation for the Treatment of Congenital Scoliosis

Wang

Meng

You

et al. 2020

Orthopaedic Surgery

View full text Add to dashboard Cite

Objectives To compare the surgical effect of children with symmetrical screw fixation and asymmetric screw fixation during posterior hemivertebra excision and short‐segment pedicle screw fixation for the treatment of congenital scoliosis (CS). Methods A total of 30 children with CS who underwent posterior hemivertebra excision and short‐segment bilateral pedicle screw fixation in our hospital from 2012 to 2018 were retrospectively included and were divided into two groups: symmetric fixation group (n = 18) and asymmetric fixation group (n = 12). The total main curve, segmental main curve, cranial compensatory curve, caudal compensatory curve, coronal balance, and apical vertebra translation were measured in the coronal plane. The segmental kyphosis, thoracic kyphosis, lumbar lordosis, and sagittal balance were measured in the sagittal plane. Results Of the 30 children, 28 hemivertebrae were resected. Twenty‐two children had one hemivertebra, three had two hemivertebrae, and five were rib deformities. The average operation time was 268 min (180–420 min). The average blood loss was 291 mL (150–550 mL). The average follow‐up was 21.1 months (12–47 months). For symmetric fixation group and there were significant differences among postoperative and follow‐up parameters including the total main curve, segmental main curve, cranial compensatory curve, caudal compensatory curve, apical vertebra translation and segmental kyphosis compared with those of preoperative parameters (P < 0.05). The postoperative coronal balance was significantly lower than preoperative coronal balance (P < 0.05). The follow‐up thoracic kyphosis was significantly higher than preoperative and postoperative thoracic kyphosis (P < 0.05). For asymmetric fixation group, the postoperative and follow‐up parameters including the total main curve, segmental main curve, cranial compensatory curve, caudal compensatory curve, apical vertebra translation, and segmental kyphosis had statistical differences compared with those of preoperative parameters (P < 0.05). The postoperative sagittal balance was significantly higher than preoperative postoperative (P < 0.05). There were no significant differences in the postoperative and follow‐up correction rate and correction loss between the two groups (P > 0.05). There were three complications in 30 children in our study, including two cases who had poor wound healing, and the wound healed smoothly after half a month of sterile dressing change. Postoperative curve progression occurred in one case after T12 and L3 hemivertebra resection and thoracic hemivertebra resection was planned again. Conclusion For pedicles which were difficult for screw fixation, adjacent segments can be chosen for screw fixation and it is safe and effective for vertebral pedicles ≤3 without internal fixation.

show abstract

Hemivertebra Resection With Instrumented Fusion by Posterior Approach in Children

Abstract: We concluded that HV resection by posterior approach-only with instrumentation is a simple, secure, reliable, less invasive and well tolerated technique that can successfully resolve this kind of congenital scoliosis in children.

Cited by 21 publications

References 29 publications

Is There Still a Place for Convex Hemiepiphysiodesis in Congenital Scoliosis in Young Children? A Long-Term Follow-up

Is There Still a Place for Convex Hemiepiphysiodesis in Congenital Scoliosis in Young Children? A Long-Term Follow-up

Konjenital Skolyoz Tanı ve Tedavisi

Individualized Study of Posterior Hemivertebra Excision and Short‐Segment Pedicle Screw Fixation for the Treatment of Congenital Scoliosis

Contact Info

Product

Resources

About