Posterior hemivertebra resection and short-segment fusion with lateral mass screws in congenital scoliosis: a novel strategy for the resource-limited setting

Abstract

Background Posterior hemivertebra resection and short-segment fusion with pedicle screws are an established treatment in congenital scoliosis, which require pediatric-specific instrumentation. The purpose of this study was to report the results of utilizing cervical lateral mass screws instead of pedicle screws in the treatment of congenital scoliosis in children younger than 5 years old. Methods In an IRB-approved retrospective chart review study, patients <5 years old with congenital scoliosis who underwent posterior hemivertebra resection and fusion with lateral mass screws from 2013 to 2017 were included. Demographic information, pre- and post-operative radiographs, complications, and outcomes were extracted from the charts. Results Twenty-three patients were included in the final analysis with a mean age of 40 months, of which 14 were female. Patients were followed for a mean of 51.3±13.2 months. The mean blood loss was 210ml, and patients were hospitalized for a mean of 4 days post-operatively. The correction rate of the main coronal curve, compensatory cranial curve, compensatory caudal curve, and segmental sagittal curve was 74.8%, 68%, 65.2%, and 68.9%, respectively. Three complications were observed: one intra-operative pedicle fracture, one case of implant failure, and one deep surgical-site infection, all of which were successfully managed. Conclusions Our findings suggest that adult lateral mass screws can be used for transpedicular fixation of the thoracic and lumbar vertebrae in low-resource settings where pediatric-specific pedicle instruments are not readily available. The correction rate, outcomes, and complications are similar and comparable to pediatric-specific pedicle screws, in addition to being low-profile and less bulky compared to adult implants.

Congenital Cervical Scoliosis Treated with Concave Side Distraction with Three‐Dimensional Printed Titanium Cage

“…Although CS due to hemivertebra may show spontaneous improvement, early surgical intervention for hemivertebra is advocated by most surgeons 19 . Hemivertebrotomy has been widely used to treat scoliosis deformity in recent years 20,21 . However, to avoid hemivertebrotomy or osteotomy and reduce possible neurological complications, we attempted to ameliorate the coronal scoliosis deformity using a concave distraction method.…”

“… 19 Hemivertebrotomy has been widely used to treat scoliosis deformity in recent years. 20 , 21 However, to avoid hemivertebrotomy or osteotomy and reduce possible neurological complications, we attempted to ameliorate the coronal scoliosis deformity using a concave distraction method. The results showed satisfactory outcomes.…”

Effects of one-stage posterior hemivertebrectomy for hemivertebral imbalance on spinal imbalance and shoulder balance: A retrospective study

“…Posterior HV excision combined with short-segment pedicle screw xation can maintain the normal development of the spine and thorax as much as possible and correct spinal deformity. Currently, it is the most common surgical method for correcting CS caused by HV [13,14,21].…”

Kết Quả Phẫu Thuật Lấy Bỏ Thân Đốt Sống Dị Tật, Kết Hợp Nẹp Vít Qua Cuống Lối Sau Điều Trị Gù Vẹo Cột Sống Do Dị Tật Nửa Thân Đốt Sống Tại Bệnh Viện Hữu Nghị Việt Đức

“…Tỉ lệ phân đoạn hoàn toàn/phân đoạn không hoàn toàn trong nghiên cứu của chúng tôi là 2,56/1. Kết quả này cũng tương tự với một số tác giả Zarei 2,43/14 . Chưa tác giả nào ghi nhận trường hợp không phân đoạn hoặc đốt sống bị cầm tù cần phải phẫu thuật.Phẫu thuật cắt thân đốt phía sau kết hợp vít qua cuống được Harms giới thiệu vào năm 1991.…”