Hemi-epiphysiodesis for unclassified congenital scoliosis: immediate results and mid-term follow-up

Abstract

Complex spinal anomalies involved in congenital scoliosis consist of a jumble of vertebral defects. Progressive scoliotic curves are frequently encountered in these patients. We evaluated the results of hemi-epiphysiodesis for this patient population. A series of ten patients with unclassified scoliosis, involving multiple hemivertebrae and/or bars, was reviewed retrospectively. Hemi-epiphysiodesis was the primary treatment in all patients. Mortality, complications and wound healing problems did not occur. The average Cobb angle for all patients changed from 54 degrees (range: 40 degrees -74 degrees), preoperatively, to 58 degrees (range: 30 degrees -104 degrees), postoperatively. Applying the criterion of a minimum change of 20 degrees, to take into account measurement variability, an epiphysiodesis effect was achieved in two procedures, progression was arrested in six procedures and failure occurred in two procedures. The mean rate of Cobb angle change per annum decreased from 2.9 degrees (range: -35 degrees to 14 degrees), preoperatively, to 2.4 degrees (range: -4 degrees to 13 degrees), following surgery. Repeat surgery was necessitated by coexisting progressive kyphosis and pseudoarthrosis in one patient, and involved extension of primary epiphysiodesis in two patients. A mean intervention-free period of 58 months was established. These results suggest that hemi-epiphysiodesis stabilized the unclassified congenital scoliosis. Being under 5 years of age, having a thoracolumbar curve location, and the absence of coexisting kyphosis were found to be associated with a more favorable outcome.

Convex Instrumented Hemiepiphysiodesis with Concave Distraction: A Preliminary Report

“…However, additional followup and imaging studies are needed to confirm whether pedicle screws will control anterior growth or provide anterior convex growth arrest. The immediate correction rates were better and the final followup Cobb angles and kyphosis angles compared favorably with those reported in other series of conventional CGA [15,16,18,[20][21][22]. The end result of uninstrumented CGA reportedly controls the coronal curve (stabilization effect), improvement in curve size (correction effect), and increase in curve size (progression) [2, 7, 9, 10-12, 15, 16, 18, 20-22].…”

“…The CGA procedure [19] has been a well-accepted approach because it reportedly is a simpler procedure when compared with other surgical alternatives and it provides successful results [14,[16][17][18][19][20][21][22]. Several studies have documented an epiphysiodesis effect in the majority of patients with control of the deformity [11,18], whereas the correction effect is observed less frequently [1,2,7,10,14,16,[20][21][22]. Problems with CGA include unpredictability of curve behavior, slow or inadequate correction, necessity of anterior surgery for completeness of the epiphysiodesis, poor control of the deformity in long sweeping curves greater than 50°, and inability to control trunk balance immediately until some spontaneous correction occurs years after the index procedure [19].…”

Thoracolumbar Hemivertebrae Resection by Double Approach in a Single Procedure

“…Case 24 had satisfactory correction of scoliosis angle, but a progressive kyphosis needed a vertebral osteotomy and definitive arthrodesis (performed at 14.4 years of age). Additional implant removal procedures were performed in 11 cases (Cases 8,9,16,17,19,20,21,24,25,26,and 30). No additional surgery was necessary for 16 patients.…”

A single posterior approach for multilevel modified vertebral column resection in adults with severe rigid congenital kyphoscoliosis: a retrospective study of 13 cases

“…VCR enables translation of spinal column and offers the advantage of a controlled manipulation of both the anterior and posterior column with active reconstruction [10,24]. Combined anterior and posterior VCR requires a lengthy operation and has the possibility to harm the anterior vascular and visceral structures [18,32,35]. For severe rigid adult congenital spinal kyphoscoliosis, it is a common practice that more than one VCR has to be done to provide enough correction with substantial risks.…”