Posterior hemivertebra resection with transpedicular instrumentation: early correction in children aged 1 to 6 years

Abstract

Study design: Retrospective study with clinical evaluation of posterior hemivertebra resection with transpedicular instrumentation in very young children.

Objective: Assessment of early intervention in congenital scoliosis by posterior approach with transpedicular instrumentation.

Summary of background data: Hemiepiphysiodesis and hemiarthrodesis are unpredictable in their effects. Hemivertebra resections in older children often require a long fusion segment because of secondary structural curves.

Materials and methods: Twenty-eight consecutive cases of congenital scoliosis in very young children were operated on by hemivertebra resection by a posterior-only approach with transpedicular instrumentation. Mean age at time of surgery was 3 years and 4 months. They were retrospectively studied with a mean follow-up of 3.5 years.

Results: Mean Cobb angle of the main curve was 45 degrees before surgery, 14 degrees after surgery, and 13 degrees at latest follow-up. Compensatory cranial curve improved from 17 degrees before surgery to 5 degrees after surgery, compensatory caudal curve improved from 22 degrees to 8 degrees. The angle of kyphosis was 22 degrees before surgery and 10 degrees after surgery. There was one infection, two pedicle fractures, and three implant failures. In two patients additional operations were performed because of new developing deformities.

Conclusions: Correction surgery of congenital scoliosis should be performed early, before the development of severe local deformities and secondary structural changes, especially in patients with expected deterioration. Posterior resection of the hemivertebra with transpedicular instrumentation allows for early intervention in very young children. Excellent correction in the frontal and sagittal planes, and a short segment of fusion allows for normal growth in the unaffected parts of the spine.