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Is single posterior approach sufficient for effective hemivertebra resection and correction of nonflexible curves? A prospective study. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1097/bco.0000000000001058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Barik S, Mishra D, Gupta T, Yadav G, Kandwal P. Surgical outcomes following hemivertebrectomy in congenital scoliosis: a systematic review and observational meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:1835-1847. [PMID: 33742234 DOI: 10.1007/s00586-021-06812-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/28/2021] [Accepted: 03/07/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Hemivertebrectomy is widely used definitive correction surgery in congenital scoliosis due to hemivertebrae. It may be done either as combined anterior and posterior approach or a single-stage posterior approach only. The purpose of this meta-analysis was to compare two techniques with regards to blood loss, operative time, deformity correction and complications. METHODS The systematic review and meta-analysis were conducted according to PRISMA guidelines among peer-reviewed journals published in English between June 2000 and June 2020. Quality appraisal of all selected articles was done and data extracted. RESULTS After thorough literature search and excluding, 37 studies were included for review. The commonest location of the hemivertebrae was thoracolumbar spine (51.3%), thoracic (26.2%), lumbar/lumbosacral (21.6%) followed by cervical (0.7%). Pooled data showed a significant difference (p < 0.05) in mean operative time with posterior only approach (227 min, 95% CI 205-250) as compared to Combined Anterior Posterior Approach (CAPA) (316 min 95% CI 291-341). Significant difference (p < 0.05) in mean blood loss was observed in posterior only approach (522 ml, 95% CI 434-611) as compared to CAPA (888 ml, 95% CI 663-1113). No significant difference was noted in mean correction in either of the approaches and overall pooled mean correction rate was 66%, 95% CI 61-72. CONCLUSION This review and meta-analysis of two surgical techniques of hemivertebrectomy, shows that operative time and blood loss is significantly lower in posterior only approach with no difference in correction rate as compared to CAPA. There was significant correlation between age at surgery and need for revision surgeries. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Sitanshu Barik
- Department of Orthopedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Dipun Mishra
- Department of Orthopedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Tushar Gupta
- Department of Orthopedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Gagandeep Yadav
- Department of Orthopedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Pankaj Kandwal
- Department of Orthopedics, All India Institute of Medical Sciences, Rishikesh, India.
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Tu Q, Chen H, Ding HW, Yu GW, Miao QJ, Shen JJ, Huang XH, Tang Y, Xia H, Xu JZ. Three-Dimensional Printing Technology for Surgical Correction of Congenital Scoliosis Caused by Hemivertebrae. World Neurosurg 2021; 149:e969-e981. [PMID: 33508486 DOI: 10.1016/j.wneu.2021.01.063] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 01/13/2021] [Accepted: 01/15/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study aimed to explore the clinical application of three-dimensional (3D) printing technology in the surgical treatment of congenital scoliosis caused by hemivertebrae. METHODS Twenty-four patients (11 in the 3D-printing group and 13 in the conventional group) with scoliosis secondary to a single hemivertebra were retrospectively reviewed. All patients underwent hemivertebrectomy and short-segment fixation. Virtual preoperative planning, operation simulation, and intraoperative application of 3D-printed patient-specific templates were performed in the 3D-printing group. Hemorrhage volume, operation time, transfusion, and complications were noted. Radiographic parameters were evaluated preoperatively, postoperatively, and at final follow-up. RESULTS All patients had different degrees of successfully corrected scoliosis. There was a similar correction of the Cobb angle postoperatively between the 2 groups. The operation time, blood loss, transfusion, time for the insertion of each screw, accuracy of screw placement, and complication rate in the 3D-printing group were significantly superior to those in the control group. No patient experienced major complications. No significant correction loss or instrument dysfunction was observed during follow-up. CONCLUSIONS As a viable and effective auxiliary technology, 3D printing makes it possible for surgery to meet both surgeon-specific and patient-specific requirements. 3D-printed individualized templates allow surgery for the correction of congenital scoliosis to enter a new stage of personalized precision surgery.
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Affiliation(s)
- Qiang Tu
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, China; Department of Orthopaedics, General Hospital of Southern Theatre Command of PLA, Guangdong, China; Department of Orthopaedics, The First School of Clinical Medicine, Southern Medical University, Guangdong, China
| | - Hu Chen
- Department of Orthopaedics, General Hospital of Southern Theatre Command of PLA, Guangdong, China; Department of Orthopaedics, The First School of Clinical Medicine, Southern Medical University, Guangdong, China
| | - Huan-Wen Ding
- South China University of Technology School of Medicine, Guangdong, China; Department of Orthopaedics, Guangzhou No.1 People's Hospital, Guangzhou, China
| | - Guang-Wen Yu
- Department of Sports Medicine, Guangzhou Orthopaedic Hospital, Guangdong, China
| | - Qiu-Ju Miao
- South China University of Technology School of Medicine, Guangdong, China
| | - Jian-Jian Shen
- Department of Spinal Surgery, Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Guangdong, China
| | - Xian-Hua Huang
- Department of Orthopaedics, General Hospital of Southern Theatre Command of PLA, Guangdong, China
| | - Yong Tang
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Hong Xia
- Department of Orthopaedics, General Hospital of Southern Theatre Command of PLA, Guangdong, China
| | - Jian-Zhong Xu
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, China.
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A review of the hemivertebrae and hemivertebra resection. Br J Neurosurg 2020; 36:546-554. [PMID: 33322933 DOI: 10.1080/02688697.2020.1859088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Hemivertebra (HV) is a congenital spinal abnormality. Most hemivertebrae have normal growth plates so create a progressive deformity with growth leading to asymmetric loads on adjacent vertebrae which also show an asymmetric growth. We review the condition and its treatment.
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Wang C, Meng Z, You DP, Zhu H, Wang F, Liu JH, Zhao S. Individualized Study of Posterior Hemivertebra Excision and Short-Segment Pedicle Screw Fixation for the Treatment of Congenital Scoliosis. Orthop Surg 2020; 13:98-108. [PMID: 33258309 PMCID: PMC7862179 DOI: 10.1111/os.12838] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 09/13/2020] [Accepted: 09/28/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To compare the surgical effect of children with symmetrical screw fixation and asymmetric screw fixation during posterior hemivertebra excision and short-segment pedicle screw fixation for the treatment of congenital scoliosis (CS). METHODS A total of 30 children with CS who underwent posterior hemivertebra excision and short-segment bilateral pedicle screw fixation in our hospital from 2012 to 2018 were retrospectively included and were divided into two groups: symmetric fixation group (n = 18) and asymmetric fixation group (n = 12). The total main curve, segmental main curve, cranial compensatory curve, caudal compensatory curve, coronal balance, and apical vertebra translation were measured in the coronal plane. The segmental kyphosis, thoracic kyphosis, lumbar lordosis, and sagittal balance were measured in the sagittal plane. RESULTS Of the 30 children, 28 hemivertebrae were resected. Twenty-two children had one hemivertebra, three had two hemivertebrae, and five were rib deformities. The average operation time was 268 min (180-420 min). The average blood loss was 291 mL (150-550 mL). The average follow-up was 21.1 months (12-47 months). For symmetric fixation group and there were significant differences among postoperative and follow-up parameters including the total main curve, segmental main curve, cranial compensatory curve, caudal compensatory curve, apical vertebra translation and segmental kyphosis compared with those of preoperative parameters (P < 0.05). The postoperative coronal balance was significantly lower than preoperative coronal balance (P < 0.05). The follow-up thoracic kyphosis was significantly higher than preoperative and postoperative thoracic kyphosis (P < 0.05). For asymmetric fixation group, the postoperative and follow-up parameters including the total main curve, segmental main curve, cranial compensatory curve, caudal compensatory curve, apical vertebra translation, and segmental kyphosis had statistical differences compared with those of preoperative parameters (P < 0.05). The postoperative sagittal balance was significantly higher than preoperative postoperative (P < 0.05). There were no significant differences in the postoperative and follow-up correction rate and correction loss between the two groups (P > 0.05). There were three complications in 30 children in our study, including two cases who had poor wound healing, and the wound healed smoothly after half a month of sterile dressing change. Postoperative curve progression occurred in one case after T12 and L3 hemivertebra resection and thoracic hemivertebra resection was planned again. CONCLUSION For pedicles which were difficult for screw fixation, adjacent segments can be chosen for screw fixation and it is safe and effective for vertebral pedicles ≤3 without internal fixation.
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Affiliation(s)
- Chen Wang
- Department of Orthopaedics, Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Zhao Meng
- Department of Orthopaedics, Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Dian-Ping You
- Department of Orthopaedics, Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Hua Zhu
- Department of Orthopaedics, Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Fei Wang
- Department of Orthopaedics, Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Jun-Hang Liu
- Department of Orthopaedics, Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Shuo Zhao
- Department of Orthopaedics, Children's Hospital of Hebei Province, Shijiazhuang, China
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Nikova A, Chatzipaulou V, Malkots B, Mustafa RM, Valsamidou C, Birbilis T. Correlation between Age and Surgical Approach for Thoracic and Lumbar Hemivertebra. INDIAN JOURNAL OF NEUROSURGERY 2020. [DOI: 10.1055/s-0040-1710103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Abstract
Objective Hemivertebra (HV) is a congenital defect of the formation of the spinal vertebra, which can result in scoliosis or kyphosis along with the related symptomatology of spine deformity. More often than not, it is linked to other abnormalities and requires attention. Its management is surgical and it is of great importance for the physician to choose the right approach at the right time, due to its deteriorative prognosis.
Methods Due to the interest of the subject, the authors investigated the world literature between 1990 and 2018 and found 45 articles, reporting thoracic, thoracolumbar, and lumbar HV in children and its postsurgical outcome, aiming to show whether the approaches are equal in terms of the final outcome.
Results The chosen surgical method depends much on the level of the pathology. Despite this fact, after analyzing the included data, we found that the surgical techniques are unequal with regard to the purpose of achieving improvement. Age, caudal and cranial curves, segmental kyphosis, and scoliosis are factors playing a major role in this.
Conclusion If not treated, HV leads to deterioration and dysfunction. The most optimal result, however, is achieved only when the surgical approach is applied according to age and rest of the accompanying factors, which should be considered in future management planning.
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Affiliation(s)
- Alexandrina Nikova
- Department of Neurosurgery, Democritus University of Thrace Medical School, Alexandroupolis, Greece
| | - Varvara Chatzipaulou
- Department of Neurosurgery, Democritus University of Thrace Medical School, Alexandroupolis, Greece
| | - Belkis Malkots
- Department of Neurosurgery, Democritus University of Thrace Medical School, Alexandroupolis, Greece
| | - Reichan Molla Mustafa
- Department of Neurosurgery, Democritus University of Thrace Medical School, Alexandroupolis, Greece
| | - Christina Valsamidou
- Department of Neurosurgery, Democritus University of Thrace Medical School, Alexandroupolis, Greece
| | - Theodosis Birbilis
- Department of Neurosurgery, Democritus University of Thrace Medical School, Alexandroupolis, Greece
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Posterior hemivertebral resection for upper thoracic congenital scoliosis: be aware of high risk of complications. J Pediatr Orthop B 2019; 28:1-9. [PMID: 30308554 DOI: 10.1097/bpb.0000000000000538] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
The treatment of congenital hemivertebrae in the upper thoracic region is challenging. The objective of this study was to investigate the outcomes of posterior hemivertebral resection for the upper thoracic region. Twenty-one patients diagnosed with upper thoracic congenital scoliosis were included. All of them received hemivertebral resection surgery via the posterior-only approach with at least 2 years of follow-up. The radiographic parameters and Scoliosis Research Society-22 score were analyzed. All the intraoperative and postoperative complications were recorded retrospectively. The segmental main curve was 35.9° before surgery and 7.0° at the last follow-up, with an average correction rate of 80.2%. The total main curve was 44.1° before surgery and 11.6° at the last follow-up, with an average correction rate of 73.9%. The caudal compensatory curve was corrected from 20.2° to 7.1°, with an average correction rate of 64.9%. The segmental kyphosis was corrected from 30.9° to 8.9°, with an average correction rate of 65.5%. The total Scoliosis Research Society-22 score significantly improved in all patients at the last follow-up, mainly resulting from the improvement of the self-image, mental health, and satisfaction domains. The following complications were found: one pedicle fracture, two malpositioned screws, one transient neurologic deficit, one implant failure, and four postoperative curve progressions. Although good radiographic deformity correction and clinical results were achieved after surgery, the incidence rate of complications was high at 42.9%; great care should be taken to prevent them, especially for postoperative curve progression (19.0%).
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