1
|
Guo S, Zheng Y, Zhang Z, Fu D, Wang J, Li H, Qian C, Wang D. Evaluation of the efficacy of posterior hemivertebrectomy combined with two or more segments fusion. BMC Musculoskelet Disord 2024; 25:646. [PMID: 39148070 PMCID: PMC11325738 DOI: 10.1186/s12891-024-07764-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 08/07/2024] [Indexed: 08/17/2024] Open
Abstract
BACKGROUND Although early hemivertebra (HV) resection and short fusion (within 4 segments) have been successful in treating congenital HV, there is limited research comparing the outcomes of the shortest-segment fusion (2 segments) versus 3 or 4 segments, particularly in young children. To evaluate the efficacy of posterior hemivertebrectomy combined with two or more segments fusion in children under the age of 10 years with a solitary simple lower thoracic or lumbar HV (T8-L5). METHODS This retrospective study included patients under the age of 10 with lower thoracic or lumbar solitary simple HV who underwent hemivertebra resection (HVR) and transpedicular short fusion and were divided into HV ± 1 group (2 segment fusion) and HV ± 2 group (3 or 4-segment fusion). The study recorded preoperative, postoperative (1 week), and the latest follow-up radiographic parameters and complications. The results of the coronal and sagittal planes were analyzed, and the main curve, segmental scoliosis curve, compensatory scoliosis curve, segmental kyphosis curve, and trunk shift were compared. RESULTS The study included 35 patients (15 in the HV ± 1 group and 20 in the HV ± 2 group) with a mean age of 5.26 ± 2.31 years and a mean follow-up of 22.54 months (12-68). The mean preoperative Cobb angle was 32.66° ± 7.339° (HV ± 1) and 29.31°±6.642° (HV ± 2). The final Cobb angle was 10.99°± 7.837° (HV ± 1) and 8.22° ± 4.295° (HV ± 2). The main curve corrected by 72% (HV ± 1), 75% (HV ± 2) postoperatively and 67% (HV ± 1), 72% (HV ± 2) at the final follow-up (P > 0.05). There were no significant differences in the correction of the segmental scoliosis curve, compensatory scoliosis curve, segmental kyphosis curve, and trunk shift between the HV ± 1 and HV ± 2 groups (P > 0.05). The unplanned reoperation rate for HV in the thoracolumbar region (T11-L2) is significantly higher (P = 0.038). CONCLUSION In the context of solitary simple lower thoracic or lumbar HV (T8-L5), HV ± 1 segment fusion suffices and yields comparable correction outcomes in the midterm period when compared to HV ± 2. The reoperation rate exhibited a statistically significant increase in the thoracolumbar region.
Collapse
Affiliation(s)
- Shangyu Guo
- Department of Orthopedics, Children's Hospital of Fudan University, National Children's Medical Center, Wan Yuan Road, Shanghai, 201102, China
| | - Yiming Zheng
- Department of Orthopedics, Children's Hospital of Fudan University, National Children's Medical Center, Wan Yuan Road, Shanghai, 201102, China
| | - Zhiqiang Zhang
- Department of Orthopedics, Children's Hospital of Fudan University, National Children's Medical Center, Wan Yuan Road, Shanghai, 201102, China
| | - Dong Fu
- Department of Orthopedics, Children's Hospital of Fudan University, National Children's Medical Center, Wan Yuan Road, Shanghai, 201102, China
| | - Junfeng Wang
- Department of Orthopedics, Children's Hospital of Fudan University, National Children's Medical Center, Wan Yuan Road, Shanghai, 201102, China
| | - Haodong Li
- Department of Orthopedics, Children's Hospital of Fudan University, National Children's Medical Center, Wan Yuan Road, Shanghai, 201102, China
| | - Chuang Qian
- Department of Orthopedics, Children's Hospital of Fudan University, National Children's Medical Center, Wan Yuan Road, Shanghai, 201102, China.
| | - Dahui Wang
- Department of Orthopedics, Children's Hospital of Fudan University, National Children's Medical Center, Wan Yuan Road, Shanghai, 201102, China.
| |
Collapse
|
2
|
Li Q, Hu B, Yang H, Feng G, Liu L, Yang X, Song Y. Posterior concave reconstruction with cage in the surgical treatment of complex lumbar deformity caused by lumbosacral hemivertebrae. 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 2024; 33:2079-2087. [PMID: 37955750 DOI: 10.1007/s00586-023-08012-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/05/2023] [Accepted: 10/16/2023] [Indexed: 11/14/2023]
Abstract
PURPOSE To identify the clinical and radiological outcomes in the coronal and sagittal planes after treatment of congenital complex lumbosacral hemivertebrae (LSHV) with or without posterior concave reconstruction. METHODS We retrospectively reviewed a consecutive series of patients with congenital LSHV deformities treated by posterior-only hemivertebra resection. The minimum follow-up was 2 years. The patients were divided into a concave-cage group and a non-cage group. The radiographic and clinical results were compared between the two groups. RESULTS Forty patients were categorized into the cage group (n = 14) and non-cage group (n = 26). At the end of the propensity score matching analysis, 14 patients from the cage group were matched to 14 patients in the non-cage group. The lumbosacral curve and thoracolumbar/lumbar curve improved significantly in both groups at the final postoperative follow-up (P < 0.001), and the lumbosacral curve at the final follow-up was remarkably lower in the cage than non-cage group. The correction rates of the lumbosacral curve and thoracolumbar/lumbar curve were significantly higher in the cage than non-cage group. The lower lumbar lordosis improved significantly in both groups at the final postoperative follow-up (P < 0.05), and the lower lumbar lordosis at the final follow-up and its correction were remarkably higher in the cage than non-cage group (both P < 0.05). CONCLUSIONS Posterior column reconstruction with insertion of a concave cage may achieve a higher correction rate of large lower lumbar lordosis and lumbosacral coronal deformity, attain better sagittal balance, and have fewer complications related to implant failure than posterior-only hemivertebra resection in patients with congenital LSHV.
Collapse
Affiliation(s)
- Qiujiang Li
- Department of Orthopedic Surgery, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Bowen Hu
- Department of Orthopedic Surgery, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Huiliang Yang
- Department of Orthopedic Surgery, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Ganjun Feng
- Department of Orthopedic Surgery, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Limin Liu
- Department of Orthopedic Surgery, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Xi Yang
- Department of Orthopedic Surgery, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China.
| | - Yueming Song
- Department of Orthopedic Surgery, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| |
Collapse
|
3
|
Ruf M. [Surgical treatment of congenital scoliosis]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2024; 36:4-11. [PMID: 37725190 DOI: 10.1007/s00064-023-00827-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/23/2023] [Accepted: 01/25/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVE Early correction of congenital scoliosis including short fusion, while minimizing both mobility restrictions and growth impairment. INDICATIONS Congenital scoliosis with marked deformity, proven progression, significant compensatory curves, and/or impairment of trunk balance. Furthermore, in case of compression of neural structures or pain due to secondary degeneration. CONTRAINDICATIONS No absolute contraindication. SURGICAL TECHNIQUE Posterior approach to the apex of the deformity. In the growing spine the periosteum should only be touched at the levels where fusion is planned. Insertion of pedicle screws adjacent to the hemivertebra. The posterior elements of the hemivertebra are removed: lamina, joint facets, pedicle, transverse process. Resection of the accessory proximal rib in the thoracic spine. Following blunt dissection at the lateral and anterior surface of the hemivertebra, the body of the hemivertebra and the adjacent discs are resected. The resulting gap is closed by compression via transpedicular instrumentation thus correcting the scoliotic deformity. In case of synostosis or contralateral bar formation, the concave side of the spine is dissected and the synostosis osteomized. POSTOPERATIVE MANAGEMENT Early mobilization on postoperative day 1. Bracing for 12 weeks depending on stability of the instrumentation. Periodic clinical and radiographic controls until the end of growth. RESULTS Posterior hemivertebra resection with transpedicular instrumentation is considered as the standard treatment of congenital scoliosis. Correction rates of 60-80% are achieved. Cervical and lumbosacral hemivertebrae may require an additional anterior approach. In case of synostosis, bar formation, or rib synostosis, further corrective surgeries may be necessary during growth.
Collapse
Affiliation(s)
- Michael Ruf
- Zentrum für Wirbelsäulenchirurgie, Orthopädie und Traumatologie, SRH Klinikum Karlsbad-Langensteinbach, Guttmannstr. 1, 76307, Karlsbad, Deutschland.
| |
Collapse
|
4
|
Barik S, Prajapati S, Raj V, Vatkar A, Kumar V. Role of intra-operative traction in deformity correction in neuromuscular scoliosis: a systematic review and meta-analysis. Spine Deform 2023; 11:787-796. [PMID: 36971963 DOI: 10.1007/s43390-023-00682-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 03/18/2023] [Indexed: 06/13/2023]
Abstract
PURPOSE Intra-operative traction (IOT) has emerged as new modality for improving correction rates in scoliosis since it has the potential to reduce operative time and blood loss in neuromuscular scoliosis (NMS). The aim of this study is to describe the effects of IOT in deformity correction in NMS. METHODS The search was conducted in online electronic databases following the PRISMA guidelines. This review included studies on NMS which have described usage of IOT in deformity correction. RESULTS Eight studies were included in analysis and review. There was low-to-moderate heterogeneity across the studies (I2 - 42.4 to 93.9%). All the studies used cranio-femoral traction for IOT. The final Cobb's angle in coronal plane was significantly lower in the traction group as compared to the non-traction group (SMD - 0.36 95% CI - 0.71 to 0). There was a trend towards better outcomes in final obliquity (SMD - 0.78 95% CI - 1.64 to 0.09), operative time (SMD - 1.09 95% CI - 2.25 to 0.08) and blood loss (SMD - 0.86 95% CI significantly lower in the traction group as 2.15 to 0.44) but did not reach statistical significance. CONCLUSION IOT helped to achieve significant scoliotic curve correction in NMS compared to non-traction group. Despite the overall tendency of improved pelvic obliquity correction, reduced operative time and reduced blood loss as compared to a surgery without the use of IOT, it did not achieve statistical significance. Further studies which are prospective with a larger sample size and focussing on a particular etiology may be conducted which would validate the results. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Sitanshu Barik
- Department of Orthopedics, All India Institute of Medical Sciences, Deoghar, 814112, India.
| | - Shivji Prajapati
- Department of Orthopedics, All India Institute of Medical Sciences, Raipur, India
| | - Vikash Raj
- Department of Orthopedics, All India Institute of Medical Sciences, Deoghar, 814112, India
| | | | - Vishal Kumar
- Department of Orthopedics, All India Institute of Medical Sciences, Deoghar, 814112, India
| |
Collapse
|
5
|
Hu B, Wang L, Song Y, Yang X, Liu L, Zhou C. Multiple Hemivertebrae: The Natural History and Treatment of 50 Patients. Orthop Surg 2023. [PMID: 37105918 DOI: 10.1111/os.13742] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 03/24/2023] [Accepted: 03/25/2023] [Indexed: 04/29/2023] Open
Abstract
OBJECTIVE Multiple hemivertebrae (MHV) is defined as three or more hemivertebrae, and is relatively uncommon among patients with congenital scoliosis. This study aimed to compare the natural history of different kinds of MHV and describe the surgical outcome of MHV. METHODS In this retrospective cohort study, a total of 50 patients diagnosed with MHV were enrolled from June 2007 to June 2018. The medical records and radiographs of these patients were reviewed to summarize the characteristics of MHV. Patients with MHV were divided into the unbalanced (UB) group, partially unbalanced (PUB) group, and completely balanced (CB) group. Medical records and radiographs of MHV patients were reviewed to collect HV position, natural history, coronal and sagittal parameters. A Mann-Whitney U test was used to compare the radiographical data, such as the cobb angle of main curve and secondary curve, and Fisher's exact test was used to compare the patients in different kinds of MHV with surgical indication or not. RESULTS The average number of hemivertebrae was 3.6 and the average main curve was 57.5°. Twenty-four of 50 patients had associated anomalies, including four patients with sacral agenesis, one with tetralogy of Fallot, two with congenital imperforate anus, and 17 with Klippel-Feil syndrome. In 22 patients who underwent MRI imaging, three patients had mild syringomyelia and three patients had diastematomyelia. The UB and PUB groups had a larger main curve and compensatory curve than the CB group. Of the 25 patients with follow-up before surgery, the curve progression rate was highest in the UB group (12.1°/year) but similar in the PUB group (4.2°/year) and CB group (3.6°/year). All patients in the UB and PUB group met the criteria for surgery. In contrast, only 10 of 23 patients in the CB group had surgical indications. Eighteen of the 37 patients with surgical indications chose to undergo surgery and the correction rate of the main curve was 51.4%. CONCLUSIONS Early surgical intervention should be considered for most patients with UB or PUB MHV. For patients with CB MHV, surgical treatment may not be urgently needed at the first visit. Posterior hemivertebrectomy could be used for the treatment of MHV with satisfying radiographic outcome.
Collapse
Affiliation(s)
- Bowen Hu
- Department of Orthopaedic Surgery and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Linnan Wang
- Department of Orthopaedic Surgery and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Yueming Song
- Department of Orthopaedic Surgery and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Xi Yang
- Department of Orthopaedic Surgery and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Limin Liu
- Department of Orthopaedic Surgery and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Chunguang Zhou
- Department of Orthopaedic Surgery and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
6
|
Zhang W, Yao Z, Guo R, Li H, Zhao S, Li W, Zhang X, Hao C. Molecular identification of T-box transcription factor 6 and prognostic assessment in patients with congenital scoliosis: A single-center study. Front Med (Lausanne) 2022; 9:941468. [PMID: 36035411 PMCID: PMC9403053 DOI: 10.3389/fmed.2022.941468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/14/2022] [Indexed: 11/24/2022] Open
Abstract
Background Congenital scoliosis (CS) is characterized by vertebral malformations. The precise etiology of CS is not fully defined. A compound inheritance of TBX6 was identified in 10% of patients with CS in Han Chinese and formed a distinguishable subtype named TBX6-associated congenital scoliosis (TACS). Methods To investigate the variants and risk haplotype of TBX6, we recruited 121 patients with CS at Beijing Children’s Hospital. We collected the clinical characteristics and surgical treatment options and followed their postoperative prognoses. Results Eight patients (6.6%) were molecularly diagnosed with TACS and carried the previously defined pathogenic TBX6 compound heterozygous variants. All the eight patients with TACS had the typical TACS clinical feature of hemivertebrae in the lower part of the spine. These patients received posterior hemivertebra resection combined with segmental fusion. Follow-ups revealed satisfactory correction without postoperative complications. Conclusion We observed a 6.6% prevalence of TACS in our CS cohort. Follow-ups further highlighted that surgical treatment of hemivertebra resection combined with segmental fusion performed well with prognosis for patients with TACS. This could provide valuable information for CS individuals with compound heterozygosity in TBX6.
Collapse
Affiliation(s)
- Wenyan Zhang
- Beijing Key Laboratory for Genetics of Birth Defects, Beijing Pediatric Research Institute, Beijing, China
- Ministry of Education of the People’s Republic of China (MOE) Key Laboratory of Major Diseases in Children, National Center for Children’s Health, Beijing Children’s Hospital, Capital Medical University, Beijing, China
| | - Ziming Yao
- Department of Orthopedics, National Center for Children’s Health, Beijing Children’s Hospital, Capital Medical University, Beijing, China
| | - Ruolan Guo
- Beijing Key Laboratory for Genetics of Birth Defects, Beijing Pediatric Research Institute, Beijing, China
- Ministry of Education of the People’s Republic of China (MOE) Key Laboratory of Major Diseases in Children, National Center for Children’s Health, Beijing Children’s Hospital, Capital Medical University, Beijing, China
- Henan Key Laboratory of Pediatric Inherited and Metabolic Diseases, Henan Children’s Hospital, Zhengzhou Hospital of Beijing Children’s Hospital, Zhengzhou, China
| | - Haichong Li
- Department of Orthopedics, National Center for Children’s Health, Beijing Children’s Hospital, Capital Medical University, Beijing, China
| | - Shuang Zhao
- Beijing Key Laboratory for Genetics of Birth Defects, Beijing Pediatric Research Institute, Beijing, China
- Ministry of Education of the People’s Republic of China (MOE) Key Laboratory of Major Diseases in Children, National Center for Children’s Health, Beijing Children’s Hospital, Capital Medical University, Beijing, China
| | - Wei Li
- Beijing Key Laboratory for Genetics of Birth Defects, Beijing Pediatric Research Institute, Beijing, China
- Ministry of Education of the People’s Republic of China (MOE) Key Laboratory of Major Diseases in Children, National Center for Children’s Health, Beijing Children’s Hospital, Capital Medical University, Beijing, China
- Henan Key Laboratory of Pediatric Inherited and Metabolic Diseases, Henan Children’s Hospital, Zhengzhou Hospital of Beijing Children’s Hospital, Zhengzhou, China
| | - Xuejun Zhang
- Department of Orthopedics, National Center for Children’s Health, Beijing Children’s Hospital, Capital Medical University, Beijing, China
- *Correspondence: Xuejun Zhang,
| | - Chanjuan Hao
- Beijing Key Laboratory for Genetics of Birth Defects, Beijing Pediatric Research Institute, Beijing, China
- Ministry of Education of the People’s Republic of China (MOE) Key Laboratory of Major Diseases in Children, National Center for Children’s Health, Beijing Children’s Hospital, Capital Medical University, Beijing, China
- Henan Key Laboratory of Pediatric Inherited and Metabolic Diseases, Henan Children’s Hospital, Zhengzhou Hospital of Beijing Children’s Hospital, Zhengzhou, China
- Chanjuan Hao,
| |
Collapse
|
7
|
Developments in Congenital Scoliosis and Related Research from 1992 to 2021: A Thirty-Year Bibliometric Analysis. World Neurosurg 2022; 164:e24-e44. [PMID: 35248773 DOI: 10.1016/j.wneu.2022.02.117] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/25/2022] [Accepted: 02/26/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Many studies, mainly original articles and reviews, have been reported on congenital scoliosis (CS), but there is a lack of bibliometric analyses. This study aimed to systematically analyze the developments and focuses in CS and related research fields. METHODS Data were retrieved from the Web of Science Core Collection database, and the top 100 most-cited studies were analyzed emphatically. The Web of Science Results Analysis and Citation Report was used to analyze different aspects of the literature. CiteSpace was used to analyze the cooperation network, reference co-citation, burst keywords, and burst citations. RESULTS The final analysis included 749 studies. CS and related research has been rapidly expanding. Several journals have published relevant studies and most-cited studies on this topic. Cooperation was noted among authors, institutions, and countries/regions in multiple instances. Surgical techniques (hemivertebra resection/posterior vertebral column resection/vertical expandable prosthetic titanium rib/double approach/grade 4 osteotomy) was one of the most common research focuses. In addition, research on genetics and molecular biology related to CS has become an emerging trend as a result of advances in basic science. CONCLUSIONS Over time, research on CS and in related fields has gained greater attention and has been expanding continuously, showing a trend toward globalization. We recommend that researchers focus on the progress of surgical techniques, advances in molecular biology and genetics, and characteristics of CS. The top clusters, most-cited articles, and references with the strongest burst citations should be studied further.
Collapse
|