Posterior thoracolumbar hemivertebra resection and short-segment fusion in congenital scoliosis: surgical outcomes and complications with more than 5-year follow-up

Abstract

Background Treatment of congenital hemivertebra is challenging and data on long-term follow-up (≥ 5 years) are lacking. This study evaluated the surgical outcomes of posterior thoracolumbar hemivertebra resection and short-segment fusion with pedicle screw fixation for treatment of congenital scoliosis with over 5-year follow-up. Methods This study evaluated 27 consecutive patients with congenital scoliosis who underwent posterior thoracolumbar hemivertebra resection and short-segment fusion from January 2007 to January 2015. Segmental scoliosis, total main scoliosis, compensatory cranial curve, compensatory caudal curve, trunk shift, shoulder balance, segmental kyphosis, and sagittal balance were measured on radiographs. Radiographic outcomes and all intraoperative and postoperative complications were recorded. Results The segmental main curve was 40.35° preoperatively, 11.94° postoperatively, and 13.24° at final follow-up, with an average correction of 65.9%. The total main curve was 43.39° preoperatively, 14.13° postoperatively, and 16.06° at final follow-up, with an average correction of 60.2%. The caudal and cranial compensatory curves were corrected from 15.78° and 13.21° to 3.57° and 6.83° postoperatively and 4.38° and 7.65° at final follow-up, with an average correction of 69.2% and 30.3%, respectively. The segmental kyphosis was corrected from 34.30° to 15.88° postoperatively and 15.12° at final follow-up, with an average correction of 61.9%. A significant correction (p < 0.001) in segmental scoliosis, total main curve, caudal compensatory curves and segmental kyphosis was observed from preoperative to the final follow-up. The correction in the compensatory cranial curve was significant between preoperative and postoperative and 2-year follow-up (p < 0.001), but a statistically significant difference was not observed between the preoperative and final follow-up (p > 0.001). There were two implant migrations, two postoperative curve progressions, five cases of proximal junctional kyphosis, and four cases of adding-on phenomena. Conclusion Posterior thoracolumbar hemivertebra resection after short-segment fusion with pedicle screw fixation in congenital scoliosis is a safe and effective method for treatment and can achieve rigid fixation and deformity correction.

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

“…Shoulder imbalance caused by HV should also be considered. Bao et al [14] have reported improved RSH from 3.36 mm preoperatively to 1.65 mm at the nal follow-up in 27 patients with HV. Chen et al [15] conducted a study on 18 patients with cervicothoracic HV and reported that in terms of shoulder balance, both the T1 tilt angle and CA were signi cantly improved, with correction rates of 55 ± 22% and 47 ± 32%, respectively.…”

“…Posterior HV excision combined with short-segment pedicle screw xation can maintain the normal development of the spine and thorax as much as possible and correct spinal deformity. Currently, it is the most common surgical method for correcting CS caused by HV [13,14,21].…”

“…The RSH, CA, and T1 tilt angles are currently among the main indicators for evaluating shoulder balance [14,15]. According to Table 2, the differences in the imaging parameters T1 tilt angle, CA, and RSH preoperatively, postoperatively, and at the last follow-up were signi cant.…”

“…Bao et al[14] performed posterior HV resection in 27 patients with a thoracolumbar spine. The coronal plane increased from 8.45 mm preoperatively to 3.78 mm at the nal follow-up; the sagittal balance improved from 16.98 mm preoperatively to 8.71 mm at the nal follow-up.…”

Is single posterior approach sufficient for effective hemivertebra resection and correction of nonflexible curves? A prospective study

“…Although this surgery and its results have been reported previously, [20][21][22] the authors of this study aimed to convey their experience with a procedure that was not performed routinely to add to the current literature while thoroughly discussing what has been published.…”