Posterior approach lumbar and thoracolumbar hemivertebra resection in congenital scoliosis in children under 10 years of age: results with 3 years mean follow up

Abstract

Introduction: The authors present 15 cases of congenital scoliosis with lumbar or thoracolumbar hemivertebra in children under 10 years of age (mean age at the time of surgery was 5.5 years). Patients were treated by posterior hemivertebra resection and pedicle screws two levels stabilization or three or more levels stabilization in the case of deformity above or under hemivertebra or for severe curve deformities.

Materials and methods: All operated patients had worsening curves; mean follow up was 40 months. The mean scoliosis curve value was 44° Cobb, and reduced to a mean 11° Cobb after surgery. The mean segmental kyphosis value was 19.7° Cobb, and reduced to a mean -1.8° Cobb after surgery. We did not consider total dorsal kyphosis value as all hemivertebras treated were at lumbar or thoracic lumbar level. No major complications emerged (infections, instrumentation mobilization or failure, neurological or vascular impairment) and only one pedicle fracture occurred.

Results: Our findings show that the hemivertebra resection with posterior approach instrumentation is an effective procedure, which has led to significant advances in congenital deformity control, which include excellent frontal and sagittal correction, excellent stability, short segment arthrodesis, low neurological impairment risk, and no necessity for further anterior surgery.

Conclusion: Surgery should be considered as soon as possible in order to avoid severe deformity and the use of long segment arthrodesis. The youngest patient we treated, with a completed dossier at the end the follow up was 24 months old at the time of surgery; the youngest patient treated by this procedure was 18 months old at the time of surgery.

Fig. 1

Female aged 25 months, L1–L2 hemivertebra. a AP LL X-rays, b AP LL X-rays detail, c AP X-rays after surgery in brace, d AP LL X-rays 1 year follow up, e AP LL X-rays 4 years follow up

Fig. 2

Male aged 4 years, L4–L5 hemivertebra, a AP LL X-rays, b CAT scan detail, c CAT scan 3D reconstruction, d AP LL X-rays after surgery in brace, e AP LL X-rays detail 3 years follow up

Fig. 3

Male aged 32 months, L5–S1 hemivertebra, a AP X-rays, b MRI scan, c AP LL X-rays after surgery, d AP LL X-rays 1 year follow up, e AP LL X-rays 3 years follow up, f AP LL X-rays 4 years follow up, g Clinical apparence 4 years follow up