Causes of the failure and the revision methods for congenital scoliosis due to hemivertebra

Abstract

The purpose of this study was to retrospectively investigate the causes of failure in the first operation and the revision procedure for patients with congenital scoliosis due to hemivertebra. Nineteen patients who underwent the revision operations because of failure in the first operation were included in this study. All the malformations were identified as fully segmented hemivertebra, including 16 cases in thoracolumbar vertebra (T10: three patients; T12: seven patients; L1: six patients), and three cases in thoracic vertebra (T8). The causes of failure in the first operation and the outcome of revision procedure for patients were retrospectively analyzed. All patients were successfully performed the personalized revision surgeries. The failure reasons of the first operation included limitations of the first operation procedure, no or incomplete resection of the malformed hemivertebra, improper operation during surgery, improper internal fixation material, and improper internal fixation scope. The average postoperative scoliosis Cobb's angle and kyphosis Cobb's angle were corrected from 54.1°preoperatively to 23.1°postoperatively, and 59.3°preoperatively to 25.8°post-operatively, respectively. The average postoperative distance between the C7 plumb line and the center sacral vertical line was decreased from 2.5 cm preoperatively to 1.5 cm postoperatively. The average follow-up period was 2.2 years. No serious complication was observed. The cause of the failure of the first operations for the congenital scoliosis due to hemivertebra is verified. Our study may provide a basis for the treatment of congenital scoliosis due to hemivertebra.

Emerging S-shaped curves in congenital scoliosis after hemivertebra resection and short segmental fusion

“…Although the type and cause of deformity are various, these progressive deformities reported in previous literature have a common ground, that the postoperative deformity develops on the hemivertebra resection level or surgical fusion area [8,12,14,16]. In contrast, the progressive curve developing in present congenital patients actually have little correlation with the initial surgical segment.…”

“…With the wide application of posterior hemivertebra resection and short fusion, the number of these cases has steadily increased, and the surgical complications have gradually become another prominent problem besides deformity correction by surgery itself [8,12,[14][15][16]. The postoperative new deformity is one of the most common complications in this surgery.…”

“…The second point is the excess damage that may have been caused in the facet capsules or supraspinous ligament above the fusion segments during exposure, which directly related to the occurrence of PJK. Shi et al [14] reported 19 patients with a hemivertebra that underwent revision surgery because of the deformity progression after their first operation. No incomplete resection of the malformed hemivertebra or failure in internal fixation or pseudarthrosis has been recognized as the main cause of their development deformity after hemivertebra resection and fusion.…”

“…Behind these successful results, the potential complications, especially postoperative progressive deformities, have been given more and more attention in recent literatures [8,12,[14][15][16].…”

long-term results after the one-stage posterior-only surgical correction of thoraco-lumbar kyphoscoliosis in congenital spine deformity caused by two ipsilateral hemi-vertebrae

“…Shi Z et al investigate the causes of failure in the rst operation and the revision procedure for patients with congenital scoliosis due to HV [19]. They suggested that limitations of the primary surgery, no or incomplete resection of HV, improper operation during surgery, improper internal xation material and xation scope were main cause of revision surgery.…”