Thoracolumbar Hemivertebrae Resection by Double Approach in a Single Procedure

Bollini, G.; Docquier, Pierre-Louis; Viehweger, Elke; Launay, Franck; Jouve, Jean-Luc

doi:10.1097/01.brs.0000224176.40457.52

Cited by 94 publications

(62 citation statements)

References 38 publications

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“…In the past two decades, many authors described hemivertebra excision by a combined anterior and posterior approach in one-or-two-stage procedures. Bollini [4] reported a long follow-up in cases of hemivertebra resection by a combined anterior and posterior approach performed in a single stage procedure. Ruf and Harms [5,6] used a hemivertebra resection by posterior resection only with transpedicular instrumentation in early correction even in very young patients; other authors have more recently described similar procedures [9,10].…”

Section: Introductionmentioning

confidence: 99%

Posterior approach lumbar and thoracolumbar hemivertebra resection in congenital scoliosis in children under 10 years of age: results with 3 years mean follow up

2013

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Section: Introductionmentioning

confidence: 99%

Posterior approach lumbar and thoracolumbar hemivertebra resection in congenital scoliosis in children under 10 years of age: results with 3 years mean follow up

2013

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“…a, b Preoperative photographs showed scoliosis with trunk tilt to left; c preoperative coronal Cobb angle was 102°; d bending Cobb angle was 87°; e preoperative thoracic kyphosis was 35°; f, g 3D-CT reconstruction showed that the UUB was located at vertebrae T6-7, T8-11 and L1-2; h postoperative coronary Cobb angle was 38°, with a correction rate of 63% and balanced coronal plane; i postoperative thoracic kyphosis was 27°; j, k the postoperative photographs showed good trunk balance; l, m no loss of correction was found in either the coronal or sagittal plane 2 years after the operation Eur Spine J (2012) 21:498-505 503 failures of formation. There have been a number of reports on the surgical management of scoliosis due to the presence of hemivertebrae and most authors have reported good clinical results [1,9,10]. The incidence of scoliosis due to failure of segmentation is not known.…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment of severe congenital scoliosis with unilateral unsegmented bar by concave costovertebral joint release and both-ends wedge osteotomy via posterior approach

Qingsong

Zhou

et al. 2011

Eur Spine J

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Introduction Congenital scoliosis with unilateral unsegmented bar has remained a surgical challenge. If it is treated with a traditional release of the convex side and an apical wedge osteotomy, there is a risk of bony bridge fracture on the concave side and spine translation during correction maneuvers, which may then result in spinal cord injuries. The authors developed a technique that consists of a concave-side costovertebral joint release followed by both-ends wedge osteotomy via a posterior-only approach. In this article, we describe the technique in detail, and present the results of ten patients treated with this technique. Methods A total of ten patients with congenital scoliosis with unilateral unsegmented bar, who had undergone a concave-side costovertebral joint release followed by both-end wedge osteotomy via a posterior-only approach were followed up for a mean of 34 months (range 26-48 months). The radiographic parameters and clinical records were all reviewed and analyzed. Results Body height increased by a mean of 7.3 cm (range 6.0-9.0 cm). The preoperative coronal Cobb angle was 102°(range 83°-139°) with a mean flexibility of 14%. At the most recent follow-up visit, the mean Cobb angle was 35°(range 12°-53°) and the mean correction rate was 66%. The coronal imbalance improved from 3.4 cm (range 0.8-6.3 cm) preoperatively to 1.1 cm (range 0.6-1.8 cm) postoperatively, a 67% correction. There were no definite pseudarthroses, no implant failure, and no obvious loss of correction in the follow-up period. Complications included one patient with hemopneumothorax and another patient with incomplete paralysis of the left lower extremity caused by a pedicle screw violating the spinal canal at the T5 level. The screw was removed 4 h after the initial operation, and the patient fully recovered after 3 months. Conclusion We have had good results with our technique of concave-side costovertebral joint release and both-end wedge osteotomy. It has the advantage of remnant anulus fibrosus, the ligamentum flavum, and the facet joints on the concave side serving both as a hinge and to minimize translation of the spine ends. It can provide excellent threedimensional curve correction for patients with severe rigid congenital scoliosis with unilateral unsegmented bar.

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“…The early diagnosis and treatment of these congenital deformities by resection and short level fusion appears to result in better deformity correction [7,8] than when correction is performed at a later age [9][10][11]. Furthermore, there is some suggestion that the use of a posterior approach alone results in a better longterm correction compared with a combined anterior/posterior approach [6,12].…”

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confidence: 99%

Fusionless posterior hemivertebra resection in a 2-year-old child with 16 years follow-up

et al. 2012

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Purpose We present the case of a 2-year-old patient with congenital scoliosis due to a lumbar hemivertebra. The current gold standard treatment of such an abnormality would be hemivertebra resection and short level posterior spinal fusion. However, due to the young age of the patient, we considered that application of a fusionless solution might offer advantages in terms of retaining normal segmental motion and the potential for growth. Methods The incarcerated hemivertebra was resected and the facet joints of the neighbouring vertebrae were joined to create a new functional motion segment and correct the kyphoscoliotic deformity. Transpedicular screws were inserted on the convex side in L2 and L3 and a tension band was applied. Results 16 years after the surgery, the patient was completely pain-free, motion of the lumbar spine was preserved and the physiological curvatures were maintained. Conclusion To our knowledge a fusionless surgical solution for the treatment of a hemivertebra has never been described before. Although this is only a single case, the good result with a long follow-up suggests the technique is worthwhile considering when planning the treatment of a lumbar hemivertebra in very young children.

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Thoracolumbar Hemivertebrae Resection by Double Approach in a Single Procedure

Abstract: This procedure is safe and offers a persistent correction with a short segment fusion. Surgery should be performed as early as possible to avert severe local deformities and prevent secondary structural deformities in order to avoid extensive fusions.

Cited by 94 publications

References 38 publications

Posterior approach lumbar and thoracolumbar hemivertebra resection in congenital scoliosis in children under 10 years of age: results with 3 years mean follow up

Posterior approach lumbar and thoracolumbar hemivertebra resection in congenital scoliosis in children under 10 years of age: results with 3 years mean follow up

Surgical treatment of severe congenital scoliosis with unilateral unsegmented bar by concave costovertebral joint release and both-ends wedge osteotomy via posterior approach

Fusionless posterior hemivertebra resection in a 2-year-old child with 16 years follow-up

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