Convex Instrumented Hemiepiphysiodesis with Concave Distraction: A Preliminary Report

Alanay, Ahmet; Dede, Özgür; Yazıcı, Muharrem

doi:10.1007/s11999-011-1878-y

Cited by 25 publications

(13 citation statements)

References 21 publications

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“…The assessment and estimation of the results are difficult [ 3 ]. Although there are reports, which state that hemiepiphysiodesis can be applied successfully, especially in association with instrumented fusion techniques, it is impossible to correct the curves in patients who have developed rigid and structural curves [ 8 , 11 ]. In a multicentric study, Yaszay et al compared hemiepiphysiodesis or in situ fusion, instrumented fusion without hemivertebra excision, and instrumented hemivertebra excision.…”

Section: Discussionmentioning

confidence: 99%

The Results of Hemivertebra Resection by the Posterior Approach in Children with a Mean Follow-Up of Five Years

Ertürer

Kılınç

Gökçen

et al. 2017

Advances in Orthopedics

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Aim To evaluate the radiologic and clinical results of patients who underwent deformity correction and stabilization for congenital spinal deformities using pedicle screws after hemivertebra resection. Material and Method Nine patients, mean age 9.2, who underwent posterior hemivertebrectomy and transpedicular fixation for congenital spinal deformity and had longer than five years of follow-up were evaluated retrospectively. The hemivertebrae were located in the thoracic region in 4 patients and thoracolumbar transition region in 5 patients. The patients were evaluated radiologically and clinically in the postoperative period. Results Mean length of follow-up was 64.2 months. The mean operating time was 292 minutes. The mean blood loss was 236 mL. The average hospitalization time was 7 days. The amount of correction on the coronal planes was measured as 31%. The mean segmental kyphosis angle was 45.7 degrees preoperatively and it was measured 2.7 degrees in the follow-up period. There were no statistically significant differences between the early postoperative period and final follow-up X-rays with respect to coronal and sagittal plane deformities. Conclusion The ability to obtain a sufficient and balanced correction in the cases accompanied by long compensator curvatures that have a structural character in hemivertebra may require longer fusion levels.

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Section: Discussionmentioning

confidence: 99%

The Results of Hemivertebra Resection by the Posterior Approach in Children with a Mean Follow-Up of Five Years

Ertürer

Kılınç

Gökçen

et al. 2017

Advances in Orthopedics

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“…The lumbosacral hemivertebrae is a challenging problem. The primary goal of the treatment is to prevent the development of severe segmental deformity, early trunk shift, and long compensatory curve above, [ 8 , 11 , 12 ] due to absence of a mobile spine below the lumbosacral hemivertebrae. [ 1 , 13 ] The lumbosacral hemivertebrae resection through combined anterior and posterior approach is usually recommended with fair outcomes at long-term follow up.…”

Section: Discussionmentioning

confidence: 99%

“…According to previous reports, when compared with lumbar and thoracolumbar hemivertebrae, the lumbosacral hemivertebrae spends more operation time, causes higher neurological complication rate, and turns out with poorer correction. [ 11 ] There are several aspects affecting the radiological and clinical outcomes, including segmental deformity correction, trunk shift, and overall alignment and neurological complications.…”

Section: Discussionmentioning

confidence: 99%

One-stage posterior excision of lumbosacral hemivertebrae

Wang

Jiang

et al. 2017

Medicine

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Lumbosacral hemivertebrae causes unique problems as early trunk decompensation and long compensatory curve above. There are only a few reports on it. This case series is a fair supplement in the literatures.To evaluate the clinical and radiological outcomes of lumbosacral hemivertebrae resection through 1-stage posterior approach.Between 2005 and 2014, a consecutive series of congenital scoliosis due to lumbosacral hemivertebrae underwent hemivertebrae excision through 1-stage posterior only approach. Demographic, operative, radiological, and quality of life data were reviewed.The mean lumbosacral curve was 29 ± 7° preoperatively, 10 ± 3° postoperatively, and 13 ± 5° at the final follow up. The final correction rate was 55 ± 9%. The gravity trunk shift was 11 ± 3 mm preoperatively, 37 ± 12 mm (range, 6–49 mm) postoperatively, 14 ± 9 mm at final follow up. The rib cage shift was 36 ± 12 mm preoperatively, 19 ± 5 mm postoperatively, and 15 ± 4 mm at the final follow up. The mean blood loss was 527 ± 125 mL and the mean surgery time was 336 ± 98 minutes. The mean follow up period was 41 ± 6 months. Two patients underwent transient neurological complications, 2 had wound bad healing, and 1 got wound infection. No pseudoarthrosis and instrumentation failure was observed.One-stage posterior hemivertebrae excision could gain reasonable outcome. It is crucial to completely resect the hemivertebrae and the Y-shaped disc. Bending the rod to appropriate lordosis is helpful to close the convex side. Early surgical intervene is a preferred choice to restore the trunk balance and avoid extensive fusion. The neurological complication rate is high. Convex radiculopathy is often caused by retraction, it could recover at follow up.

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“…Very few reports and personal experiencies of different authors have been published on the subject. Using convex epiphysiodesis with concave distraction has also been suggested [ 35 ].…”

Section: Convex Epiphysiodesismentioning

confidence: 99%

Current Concepts - Congenital Scoliosis

Tikoo¹,

Kothari²,

Shah³

et al. 2017

TOORTHJ

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Background:Congenital scoliosis is one of the ‘difficult to treat’ scenarios which a spine surgeon has to face. Multiple factors including the age of child at presentation, no definite pattern of deformity and associated anomalies hinder the execution of the ideal treatment plan. All patients of congenital scoliosis need to be investigated in detail. X rays and MRI of spine is usually ordered first. Screening investigations to rule out VACTERL (Visceral, Anorectal, Cardiac, Tracheo-esophageal fistula, Renal and Lung) abnormalities are required. They are cardiac echocardiography and ultrasonography of abdomen and pelvis. CT scan is required to understand the complex deformity and is helpful in surgical planning.Methods:A comprehensive medical literature review was done to understand the current surgical and non surgical treatment options available. An attempt was made to specifically study limitations and advantages of each procedure.Results:The treatment of congenital scoliosis differs with respect to the age of presentation. In adults with curves more than 50 degrees or spinal imbalance the preferred treatment is osteotomy and correction. In children the goals are different and treatment strategy has to be varied according to the age of patient. A single or two level hemivertebra can easily be treated with hemivertebra excision and short segment fusion. However, more than 3 levels or multiple fused ribs and chest wall abnormalities require a guided growth procedure to prevent thoracic insufficiency syndrome. The goal of management in childhood is to allow guided spine growth till the child reaches 10 - 12 years of age, when a definitive fusion can be done. The current research needs to be directed more at the prevention and understanding the etiology of the disease. Till that time, diagnosing the disease early and treating it before the sequels set in, is of paramount importance.Conclusion:The primary aim of treatment of congenital scoliosis is to allow the expansion of chest and abdominal cavity, while keeping the deformity under control. Various methods can be categorized into definitive (hemivertebrectomy) or preventive (guided growth). Casting, Growth rods, Convex Epiphysiodesis are all guided growth measures. The guided growth procedure either ‘corrects the deformity’ or will have to be converted to a final fusion surgery once the child completes the spinal growth which is preferably done around 10 - 12 years of age. Future directions should aim at genetic counselling and early detection.

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Convex Instrumented Hemiepiphysiodesis with Concave Distraction: A Preliminary Report

Cited by 25 publications

References 21 publications

The Results of Hemivertebra Resection by the Posterior Approach in Children with a Mean Follow-Up of Five Years

The Results of Hemivertebra Resection by the Posterior Approach in Children with a Mean Follow-Up of Five Years

One-stage posterior excision of lumbosacral hemivertebrae

Current Concepts - Congenital Scoliosis

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