Hemivertebra Resection and Spinal Arthrodesis by Single-Stage Posterior Approach in Congenital Scoliosis and Kyphoscoliosis: Results at 9.6 Years Mean Follow-up

Abstract

Background: Congenital kyphoscoliosis due to hemivertebra is generally treated surgically because of high risk of curve progression and high risk of nervous system complications. Modern posterior access surgical techniques, including total hemivertebra resection, can completely correct deformity without additional anterior access surgeries. The purpose of this study was to evaluate midterm results of hemivertebra resection and spinal arthrodesis; the hypothesis was that it is a safe, effective, and reproducible procedure.

Materials and methods: From 2006 to 2019, hemivertebra resection and instrumented spinal arthrodesis with pedicle screws was performed on 82 patients with congenital vertebral deformities (62 scoliosis and 20 kyphoscoliosis) by posterior approach. Mean age at surgery was 8.6 years, and 22 patients were under 10 years of age. After stabilization patients have been braced for a period from 3 to 5 months.

Results: Mean follow-up was 9.6 years (range 1.2-12.8 years); mean kyphosis curve after surgery was reduced to 20° Cobb; and mean scoliosis curve was reduced to 11° Cobb. We experienced no major complications (postsurgical infection, instrumentation failure, severe neurological impairment, severe blood loss) at latest follow-up .

Conclusion: We strongly advocate one-time posterior hemivertebra resection and arthrodesis as the most suitable surgical procedure for congenital scoliosis due to hemivertebra. Posterior approach interventions with pedicle screws instrumentation are less invasive than combined anterior-posterior approach interventions. We think that posterior approach procedures can lead to excellent deformity correction in both frontal and sagittal views, optimal stability, and low risk of nervous injury.

Clinical relevance: Congenital scoliosis treatment is one of the most challeging conditions a spine surgeon has to face. We advocate that a one-stage posterior approach for hemivertebrectomy and fusion is a reliable, safe tachnique, whom excellent results remain stable at a mid/long-term follow-up.

Level of evidence: Level 4.

Keywords: congenital scoliosis; hemivertebra resection; posterior vertebral arthrodesis.

Figure 1

Preoperative x-ray images (a, b), magnetic resonance images (c), computed tomographic (CT) images (d, e), three-dimensional CT images (f, g), and clinical presentation (h–k) of the patient. Postoperative x-ray images (l, m).

Figure 2

Preoperative x-ray image (a) showing 3 hemivertebras (arrows); preoperative magnetic resonance image (b); intraoperative picture showing lumbar instrumentation (c); postoperative x-ray images (d, e); postoperative x-ray images after the second procedure (f, g); and clinical pictures at latest follow-up 8.8 years after lumbar procedure and 4.7 years after thoracic hemivertebra resection (h-j).

Figure 3

Preoperative x-ray images of a 25-month-old patient (a, b); postoperative x-ray images showing T12 left pedicle screws (arrow) after rupture of L1 left pedicle (c, d); and x-ray images at 7.3 years follow-up (e, f) showing no loss of correction.

Figure 4

Clinical presentation (a–c) and preoperative x-ray images (d, e); postoperative x-ray images with cast (f, g); and 6 months follow-up x-ray images showing proximal junctional kyphosis (h, i).

Figure 5

Preoperative x-ray images (a, b), computed tomographic (CT) images (c, d), and three-dimensional CT image (e); and clinical (f–h) and radiologic (i, j) findings at 8 months follow-up, showing small upper scoliotic curve development and slight cosmetic impairment.