One-stage posterior excision of lumbosacral hemivertebrae

Abstract

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.

The radiological outcomes of one-stage posterior-only hemivertebra resection and short segmental fusion for lumbosacral hemivertebra: a minimum of 5 years of follow-up

“…In addition, conservative treatment, including bracing and traction, has been shown to be ineffective [3, 4]. Therefore, early surgical intervention should be recommended for patients with rapid curve progression and significant trunk imbalance [1–7, 12, 13].…”

“…Previously, LSHV resection with instrumentation and fusion was performed via one-/two-stage combined anterior and posterior approaches [7–11]. However, the combined procedure is aggressive with a longer operating time and more blood loss [7, 12, 13]. With the substantial advances in posterior instrumentation, the posterior-only approach has gradually become preferred [12, 13].…”

“…However, the combined procedure is aggressive with a longer operating time and more blood loss [7, 12, 13]. With the substantial advances in posterior instrumentation, the posterior-only approach has gradually become preferred [12, 13]. However, there remains a debate regarding the selection of the most appropriate fusion level for this deformity, particularly in patients with immature skeletons [3, 4, 7].…”

“…However, there remains a debate regarding the selection of the most appropriate fusion level for this deformity, particularly in patients with immature skeletons [3, 4, 7]. Recently, short segmental fusion associated with posterior-only hemivertebra resection, due to its minimized side effects in terms of spine growth and mobility, has drawn the attention of spine surgeons [7, 12, 13].…”

“…Zhuang et al [12] and Li et al [13] demonstrated good correction of the lumbosacral curve and coronal trunk shift after posterior-only LSHV resection and short segmental fusion. However, both of the aforementioned studies were limited by a relatively short follow-up period; in particular, most of the enrolled patients were very young and far from skeletal maturity [12, 13]. How the compensatory curve and the coronal balance change during long-term follow-up remain unclear.…”