Hemivertebra resection in children, results after single posterior approach and after combined anterior and posterior approach: a comparative study

Abstract

Purpose To compare the results after hemivertebra resection through a single posterior approach and through a combined anterior and posterior approach. Methods This is a retrospective study on patients treated by hemivertebra resection with monosegmental instrumentation for congenital scoliosis at a single institution. The patients were divided into two groups according to the surgical approach. Both groups were compared for curve correction, complication rate and perioperative data. Paired samples T test was used for statistical evaluation. Results Twenty-five consecutive patients were included. In 12 cases the hemivertebra resection was performed through a single posterior approach (SPA) and in 13 via a combined anterior and posterior approach (CAPA). Curve correction was similar in both groups (59 vs. 55%, p [ 0.05). Duration of surgery (272 vs. 319 min) and postoperative mechanical ventilation were shorter in the SPA group (5 vs. 30 h), but did not reach statistical significance (p [ 0.05). Significant blood loss necessitating blood transfusion was observed in six patients operated through an SPA and in 8 patients operated through a CAPA. The duration of the ICU management (1 vs. 3 days) and the hospital stay (12 vs. 19 days) were significantly shorter in the SPA group (p \ 0.05). Less surgery related general complications were observed in the SPA group (0 vs. 38%). Conclusions Similar correction of the main and the compensatory curves can be achieved with single posterior and combined anterior and posterior hemivertebra resection. Benefits of the SPA are lower complication rate and shorter recovery period.

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

“…In earlier years, hemivertebra resection by a combined anterior and posterior approach had been advocated because of its good visualization of neural structures and less technical requirement [8,9]. Later, with the wide application of the transpedicular screw, compared with the combined approach, one stage posterior approach hemivertebra resection enjoys an almost equal correction rate but with much lower surgery-related morbidity and much shorter postoperative recovery periods [9].…”

“…Later, with the wide application of the transpedicular screw, compared with the combined approach, one stage posterior approach hemivertebra resection enjoys an almost equal correction rate but with much lower surgery-related morbidity and much shorter postoperative recovery periods [9]. In recent decades, the posterior-only hemivertebra resection has gradually replaced the combined approach and became the preferred correction for this deformity [4,5,10].…”

A modified surgical procedure for congenital kyphoscoliosis: selective partial hemivertebrectomy via posterior-only approach

“…Such anterior-posterior surgery fundamentally prevents the occurrence of crankshaft phenomenon, so it is widely applied in clinical practice [12][13][14]. But, its additional anterior wound brings more serious injury to patients with a high rate of postoperative complications, prolonging the operation time and length of inpatient stays, which results in greater economic burden to patients [15]. As the posterior-only approach is at risk for developing the crankshaft phenomenon, the safety of its application has been questioned by some authors.…”

“…Their results indicated that after an average follow-up of 4.6 years, the maintaining of correction was satisfactory in all patients, without evident The difference between preoperative and at the last follow-up crankshaft phenomenon. In 2012, a control study of Mladenov et al [15] compared the results of 12 cases receiving hemivertebra resection through a single posterior approach with 13 cases through a combined anterior and posterior approach. They found that the final therapeutic effects were almost the same.…”

Surgical Treatment of Children With Congenital Lumbar Scoliosis: Complete or Partial Resection of Malformed Vertebrae?

“…Титановый протез, установленный вместо удаленного тела аномального позвонка, обеспечи-вал прочность, стабильность на уровне передней и средней колонн позвоночника и создавал условия для восстановления физиологического фронталь-ного и сагиттального профиля позвоночника на этом уровне. удаление тела аномального позвонка у пациен-тов старшей возрастной группы является сложным и тяжелым хирургическим вмешательством и соз-дает больший риск развития неврологических на-рушений [16][17][18]. учитывая этот факт, некоторые авторы предлагают выполнять частичную резек-цию тела аномального позвонка с выше-и нижеле-жащими межпозвонковыми дисками в сочетании со стабилизацией врожденного искривления [13].…”