Evaluation and Comparation of a Novel Surgical Technique and Hemivertebra Resection to the Correction of Congenital Cervical Scoliosis in Lower Cervical and Cervicothoracic Spine

Abstract

Objective: To report concave-side distraction technique to treat congenital cervical scoliosis in lower cervical and cervicothoracic spine. To evaluate and compare clinical and radiographic results of this procedure with classic hemivertebra resection procedure.Methods: This study reviewed 29 patients in last 13 years. These patients were divided into convexside resection group (group R) and concave-side distraction group (group D). Radiographic assessment was based on parameter changes preoperatively, postoperatively and at last follow-up. Demographic data, surgical data and complications were also evaluated and compared between the 2 groups.Results: In group R, mean age was 8.9±3.3 years and follow-up was 46±18 months. Operation time and blood loss averaged 500±100 minutes, 703±367mL. In group D, mean age was 9.9±2.8 years and follow-up was 34±14 months. Operation time and blood loss averaged 501±112 minutes, 374±181mL.Structural Cobb angle was corrected from 29.4°±12.5° to 5.3° (2.1°-18.1°) (p=0.001) and 33.7°±14.1° to 12.8°±11.4° (p<0.001) in groups R and D. Compensatory Cobb angle had a spontaneous correction rate of 59.6% (40.0%-80.8%) and 59.7%±23.0% in groups R and D. Mandibular incline, clavicle angle and spine coronal balance were significantly improved at last follow-up in both groups. All correction rates were not statistically different between groups. However, group D had significant less blood loss (p=0.000) and operation time (p=0.004) per vertebra than group R. Seven patients developed C5 nerve root palsy and recovered by 6 months of follow-up. Conclusion:Both surgical procedures are safe and effective in correcting congenital cervical scoliosis.But concave-side distraction technique has less blood loss and time-consuming during surgery, which provides a better option for the treatment of congenital cervical scoliosis.

Minimally invasive spine surgery strategy for congenital cervicothoracic scoliosis in children: Less blood loss and shortened segmental fusions/fewer pedical screws

“…Congenital cervicothoracic scoliosis (CTS) poses a perplexing spinal deformity that is relatively rare and difficult to treat in young children ( 1 – 4 ). It mostly results from an osseous abnormality, namely hemivertebrae, block vertebrae, or junctional bar ( 2 – 5 ). Located at the transition zone between the relatively stiff thoracic spine and dynamic cervical segment, adjacent to the shoulders, the spinal abnormalities in this region are often associated with an obvious decompensation in the shoulders and neck, which can develop into facial asymmetry rapidly ( 2 – 6 ).…”

“…Located at the transition zone between the relatively stiff thoracic spine and dynamic cervical segment, adjacent to the shoulders, the spinal abnormalities in this region are often associated with an obvious decompensation in the shoulders and neck, which can develop into facial asymmetry rapidly ( 2 – 6 ). However, due to the limited compensation in the adjacent spine segment, conservative treatment such as spine brace treatment or serial casting, has little effect ( 3 , 5 , 7 ). Hence, when asymmetric growth of the neck and head is proven early, surgical intervention should be recommended early in the lives of children ( 1 , 2 , 7 – 9 ).…”

“…Surgical treatment is always accompanied by dissecting and bleeding, as well as the risk of neural injury ( 5 , 6 , 10 ). Of the possible osseous anomalies that can result in spinal deformities, hemivertebra(HV) is one of the most common causes ( 1 , 2 , 11 , 12 ).…”

“…On the other hand, for HV resection, the posterior-only procedure is less invasive by avoiding an anterior approach and has a slightly weaker correction than combined surgery ( 4 , 9 , 13 , 15 , 16 ). To our knowledge, few studies for operating in the cervicothoracic region have been reported ( 3 – 5 , 8 , 9 , 17 ).…”

“…In brief, the principle of minimally invasive spine surgery (MISS) is to perform with less damage to the body and fewer complications. Given that the weight of young children with congenital CTS is often lighter than that of adults, reducing intraoperative blood loss is conducive to a safer operation ( 5 , 11 , 18 ). Therefore, in order to decrease surgical incisions, and minimize surgical bleeding and the fusion of segments by the instrumentations, the authors have attempted the concept of MISS for congenital cervicothoracic spine deformities via a posterior-only approach.…”