Short fixation with a 3‐rod technique for posterior hemivertebra resection in children younger than 5 years old

Abstract

Congenital hemivertebra is commonly treated with posterior hemivertebra resection with bilateral transpedicular fixation. However, implant-related complications are common in children younger than 5 years old who undergo this surgical procedure. objective: To present the preliminary clinical and radiological outcomes of children younger than 5 years old treated by posterior hemivertebra resection and 3-rod fixation technique. methods: From January 2016 to December 2017, 14 consecutive patients of congenital scoliosis with 16 hemivertebrae were retrospectively reviewed, including 5 girls and 9 boys, aged between 25 and 55 months old (average, 37.6 months). All patients underwent posterior hemivertebra resection with short fixation with bilateral pedicle screws and a convex lamina hook. Surgical complications and corrective outcomes were assessed based on the clinical charts and spinal radiographs with a minimum 24-month follow-up. Results: The mean Cobb angle of the main curve was 38.4° before surgery, 8.5° after surgery, and 8.7° at final follow-up. In the compensatory cranial curve, the preoperative Cobb angle of 16.8° was corrected to 8.1° postoperatively and was 10.3° at final follow-up. In the compensatory caudal curve, the preoperative Cobb angle of 15.9° improved to 5.3° postoperatively and was 7.8° at final follow-up. The segmental kyphosis was corrected from 13.5° to 0.5° and was 1.1° at final follow-up. There were no crankshaft phenomena, no proximal kyphosis, and no complications related to the instrumentation. interpretation: Posterior hemivertebra resection with instrumentation with bilateral pedicle screws and a convex lamina hook can achieve rigid fixation and deformity correction. KEYwoRDS Congenital scoliosis, Hemivertebra, Lamina hook, Pedicle screw of the vertebral body, a single pedicle, and a hemilamina. 1 They may be fully segmented, semi-segmented, nonsegmented, or incarcerated. 2 Non-segmented and incarcerated hemivertebrae usually progressed gradually, How to cite this article: Guo D, Yao Z, Qi X, Li C, Zhang X. Short fixation with a 3-rod technique for posterior hemivertebra resection in children younger than 5 years old.

Molecular identification of T-box transcription factor 6 and prognostic assessment in patients with congenital scoliosis: A single-center study

“…The frequency of complications ranged from 0 to 41% ( 27 , 28 , 32 , 33 , 35 – 42 ) and complications included wound infection, adding-on phenomenon, pseudoarticulation formation, postoperative progression of scoliosis, the offset of the internal fixation, and pedicle fractures. In our previous study ( 43 ), it showed that 14 patients with CS younger than 5 years of age accepted short fixation for posterior hemivertebra resection, which had a mean correction rate of 77.86% and no surgery-related complications. With a mean correction rate of 90.84%, posterior hemivertebra resection combined with segmental fusion was more effective in patients with TACS.…”

Posterior hemivertebra resection without internal fixation in the treatment of congenital scoliosis in very young children

“…the convex epiphyseal block, and hemivertebrectomy (18). For congenital scoliosis secondary to hemivertebral deformity, posterior hemivertebrectomy is preferred (10,19,20). The age at which the patient should undergo surgery is controversial, but there is a greater consensus that surgery before 3 years of age yields better outcomes (1,14,19,21,22).…”

“…Although studies have demonstrated that the pedicle screw system is safe and effective in pediatric patients (12, 26), the is not well developed in very young children (11,25). Especially for children under 5 years old, it is difficult to maintain a good internal fixation position (20), and the failure of internal fixation implantation is a challenge for hemivertebrectomy in young children (27), mainly including complications such as pedicle fracture and internal fixation prolapse (10)(11)(12)(13). In 2003, Ruf et al (12) reported that among children under 6 years of age who underwent posterior hemivertebrectomy with transpedicular instrumentation, 3 out of 28 had failed internal fixation and 2 out of 28 had pedicle fractures.…”

“…Other reports in the literature have shown that congenital scoliosis revision surgery is mostly due to the failure of internal fixation (27) or the inappropriate choice of surgical approach (28). Very young children are sometimes less likely to have access to well-suited internal fixation devices because of their own bone developmental characteristics (20). Because there are no suitable internal fixation screws for use in these very young patients, internal fixation cannot be applied to these children who require treatment.…”