Efficacy of Hemivertebra Resection for Congenital Scoliosis

Yaszay, Burt; O’Brien, Michael F.; Shufflebarger, Harry L.; Betz, Randal R.; Lonner, Baron; Shah, Suken A.; Boachie-Adjei, Oheneba; Crawford, Alvin; Letko, Lynn; Harms, Jürgen; Gupta, Munish C.; Sponseller, Paul D.; Abel, Mark F.; Flynn, John M.; Macagno, Angel; Newton, Peter O.

doi:10.1097/brs.0b013e318233f4bb

Cited by 68 publications

(22 citation statements)

References 21 publications

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“…Surgical treatment is technically demanding and potentially dangerous in terms of neurological outcome for several reasons: the spinal cord is already “sick” and may be additionally damaged during decompression, it may be distorted or it may impinge at the edges of decompression during correction, the feeding vessels may be destroyed, and profuse blood loss or even embolization may occur [3, 4]. In this context, the observation that papers regarding childhood angular kyphosis or kyphoscoliosis are published almost exclusively by orthopedic surgeons in journals not dedicated to the pediatric population suggests that pediatric neurosurgeons should be more involved [1–4, 6, 7, 9, 10]. Indeed, they should have an important role interpreting every individual’s clinical and radiological presentation, counseling the parents, deciding whether spinal cord or spinal column should be surgically addressed first, and helping the orthopedic surgeon to safely achieve adequate spinal cord decompression prior to spinal stabilization.…”

Section: Discussionmentioning

confidence: 99%

“…The latter include cases that occur in the setting of neurofibromatosis, trauma (posttraumatic kyphosis), tuberculosis (Pott’s disease), and myelomeningocele, among others [1]. Moreover, published series are almost exclusively authored by orthopedic surgeons, suggesting that neurosurgeons in general, and pediatric neurosurgeons in particular, are not involved in caring for these children [1–4, 6, 7, 9, 10]. We present five cases that illustrate the clinical spectrum of childhood angular kyphosis, and these were treated by a multidisciplinary team including a child neurologist, an orthopedic surgeon, and a pediatric neurosurgeon as complementary partners during the decision making, surgical treatment, and follow-up process.…”

Section: Introductionmentioning

confidence: 99%

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Childhood angular kyphosis: a plea for involvement of the pediatric neurosurgeon

et al. 2017

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IntroductionChildhood angular kyphosis is rare, as most children are affected by a mixed kyphotic and scoliotic deformity. Published series involving a mix of kyphosis and kyphoscoliosis, pediatric and adult, congenital and acquired cases are almost exclusively authored by orthopedic surgeons, suggesting that (pediatric) neurosurgeons are not involved.Case seriesWe present five cases that illustrate the spectrum of angular kyphosis, and these were treated by a multidisciplinary team including child neurologist, orthopedic surgeon, and pediatric neurosurgeon as complementary partners.DiscussionAngular kyphosis is a cosmetic problem but above all a serious threat to the spinal cord and as such to the child’s ambulatory, sphincter, and genito-urinary functions. Spinal cord stretch over the internal kyphosis may cause pain and/or neurological deficit, often accompanied by myelomalacia or even segmental cord atrophy. Spinal cord function may be additionally affected by associated disorders such as syringomyelia or tethered cord, an orthopedic surgeon may be less familiar with. The decision when and how to proceed surgically should be made by a multidisciplinary team, including a pediatric neurosurgeon who actively participates in the operation and helps to safely achieve adequate spinal cord decompression and stabilization.ConclusionChildhood angular kyphosis is a complex, heterogeneous disorder that should be managed by a multidisciplinary team in specialized pediatric spine centers. While every case is truly unique, the spinal cord is always at risk, especially during decompression, stabilization, and eventual correction of deformity. Pediatric neurosurgeons have an important role to play in preoperative work-up, actual operation, and follow-up.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Childhood angular kyphosis: a plea for involvement of the pediatric neurosurgeon

et al. 2017

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“…У таких пациентов существует достаточно высокий риск осложнений, так как спинной мозг подвергается компрессии на протяжении длительного времени и может быть дополнительно поврежден при вмешательстве за счет чрезмерного натяжения, ущемления, повреждения питающих артерий или снижения перфузии [34,43]. В силу указанных причин данные вмешательства требуют обязательного участия детского нейрохирурга [5,20,27,41]. В описанном случае у пациентки возникло смещение вентрикулоперитонеального шунта.…”

Section: рисunclassified

Three-Column Osteotomy of the Spine During Revision Surgery in a Patient With Congenital Angular Thoracolumbar Kyphoscoliosis

et al. 2018

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A clinical case of surgical treatment of a female adolescent patient with multiple malformations, congenital thoracolumbar kyphoscoliosis, severe lower paraparesis and impaired functions of pelvic organs is presented with a review of the literature on the problem under consideration. During the course of treatment over several years, the patient underwent repeated revision surgical interventions because of implant instability and infectious complications. The last stage of treatment included a three-column osteotomy of the spine at the deformity apex with posterior instrumented fixation. A significant correction of the deformity was achieved. Based on the results of 18-month follow-up, the correction is maintained, the implant is stable. The patient reports a significant improvement in the quality of life.

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“…Yaszay [33] in a multicenteric trial compared three modalities i.e . hemi-epiphysiodesis or in situ fusion, instrumented fusion without hemivertebra excision, and instrumented hemivertebra excision.…”

Section: Posterior Only Hemivertebrectomy and Fusion (Figs 3 And 4)mentioning

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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Efficacy of Hemivertebra Resection for Congenital Scoliosis

Cited by 68 publications

References 21 publications

Childhood angular kyphosis: a plea for involvement of the pediatric neurosurgeon

Childhood angular kyphosis: a plea for involvement of the pediatric neurosurgeon

Three-Column Osteotomy of the Spine During Revision Surgery in a Patient With Congenital Angular Thoracolumbar Kyphoscoliosis

Current Concepts - Congenital Scoliosis

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