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Börekci A, Ekşi MŞ, Osama M, Tunçkale T, Yılmaz M, Koban O, Öğrenci A, Dalbayrak S. Circumferential Approach to Congenital Kyphoscoliosis with Hemivertebra: Adding on Rather than Resecting Could Be a Better Option in Older Adolescents. World Neurosurg 2023; 180:22-28. [PMID: 37683923 DOI: 10.1016/j.wneu.2023.08.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 09/10/2023]
Abstract
OBJECTIVE To present a new technique combining anterior release with allograft insertion and lateral fixation at the concave side of the curve, preserving the hemivertebra and posterior bilateral transpedicular fixation in patients with congenital kyphoscoliosis (CKS) who were not operated on until late adolescence, including long-term follow-up of patients, and a discussion of the literature on CKS with hemivertebra. METHODS Two patients with CKS concomitant with hemivertebra underwent circumferential (anterior-posterior) instrumentation and fusion using a new technique. RESULTS Patient 1 underwent a 2-stage operation, first anterior then posterior. Patient 2 was operated on circumferentially in 1 session. Both patients had >10 years of follow-up showing solid fusion of their operated spine segments. The patients were pain-free, and their body heights were comparable to healthy peers. CONCLUSIONS In our circumferential approach, we successfully integrated the hemivertebrae in anterior fusions rather than resecting them in older adolescents with CKS. This technique decreased bleeding, shortened operative time, and promised potential benefits compared with the available techniques in the literature.
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Affiliation(s)
- Ali Börekci
- Neurosurgery Clinic, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
| | - Murat Şakir Ekşi
- Department of Neurosurgery, Health Sciences University, Istanbul, Türkiye.
| | - Mahmoud Osama
- Department of Neurosurgery, Nasser Institute for Research and Treatment, Cairo, Egypt
| | - Tamer Tunçkale
- Department of Neurosurgery, Tekirdağ Namık Kemal University, Tekirdağ, Türkiye
| | - Mesut Yılmaz
- Private Practice of Neurosurgery, Istanbul, Türkiye
| | - Orkun Koban
- Neurosurgery Clinic, Lokman Hekim İstanbul Hospital, Istanbul, Türkiye
| | - Ahmet Öğrenci
- Neurosurgery Clinic, Medicana Ataşehir Hospital, Istanbul, Türkiye
| | - Sedat Dalbayrak
- Neurosurgery Clinic, Medicana Ataşehir Hospital, Istanbul, Türkiye
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Frank S, Piantoni L, Tello CA, Remondino RG, Galaretto E, Falconi BA, Noel MA. Hemivertebra Resection in Small Children. A Literature Review. Global Spine J 2023; 13:897-909. [PMID: 36165598 DOI: 10.1177/21925682221130060] [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] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVE To evaluate the lowest possible age to resect an HV in very young patients with a congenital deformity. METHODS We sought to retrieve all studies reporting age at HV excision in patients with congenital scoliosis. Studies written in English were included. No publication date restrictions were imposed. A search of the PubMed and LiLacs databases was conducted. Additionally, a hand search was performed to supplement the database search. RESULTS We found 140 articles. Twenty two studies were included into the final assessment. There was considerable heterogeneity in the included studies, both regarding age and the surgical techniques used. There was also a broad spectrum of recommendations regarding suggested age for treatment. The youngest patient undergoing resection and fusion was 3 months of life at the time of surgery. CONCLUSION How young a patient could and should be submitted to HV resection surgery is still a matter of debate in the literature. Prophylactic surgery might be a proper treatment for young children with congenital scoliosis before malformation becomes a deformity, adding no additional neurological, vascular, or anesthesia-related complications. The defect can be treated early while the deformity is treated late.
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Affiliation(s)
- Sofía Frank
- 36947Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Lucas Piantoni
- 36947Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Carlos A Tello
- 36947Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Rodrigo G Remondino
- 36947Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Eduardo Galaretto
- 36947Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Boris A Falconi
- 36947Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Mariano A Noel
- 36947Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
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Wang S, Zhang J, Zhang Y, Du Y, Yang Y, Lin G. Outcomes of Posterior Lumbar Hemivertebra Resection and Short Fusion in Patients With Severe Sacral Tilt. Neurospine 2021; 18:562-569. [PMID: 34610687 PMCID: PMC8497244 DOI: 10.14245/ns.2142376.188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 09/12/2021] [Indexed: 11/21/2022] Open
Abstract
Objective To introduce surgical strategies to restore coronal balance during limited fusion for early lumbar hemivertebra resection in patients with severe sacral tilt.
Methods Sacral tilt was defined as a sacral tilt angle ≥ 5, and severe sacral tilt was defined as a sacral tilt angle > 10. From July 2004 to December 2017, 73 consecutive patients treated with posterior hemivertebra resection and short fusion in our institution were evaluated. Severe sacral tilt was noted in 26 patients (14 boys and 12 girls), and all were enrolled in this study. Undercorrection of the primary lumbar curve as compensation for the sacral tilt and short fusion was performed in these patients. The medical charts and imaging data of the patients were retrospectively reviewed to evaluate the outcomes.
Results All patients were followed for at least 2 years. The mean age at the time of surgery was 3.7 (2–9) years old, with a total of 31 lumbar hemivertebra excised. On average, 2.8 (2–5) segments were fused for each patient. Sacral tilt minimally improved from 14.5° preoperatively to 13.6° postoperatively (p=0.15) and remained stable at the follow-up. The overall lumbar curve was 41.9° preoperatively, 11.7° immediately postoperatively, and 14.6° at the final follow-up. The segmental scoliosis curve was 39.1° preoperatively, 9.7° immediately postoperatively, and 11.2° at the final follow-up. Segmental kyphosis was corrected from 27.2° to 6.5° after the surgery and was 7.1° at the latest follow-up.
Conclusion Sacral tilt is seen in patients with congenital scoliosis in lumbar hemivertebra. Undercorrection of the lumbar curve and segmental scoliosis to compensate for sacral tilt and short fusion after hemivertebra resection may be helpful to restore coronal balance and preserve mobility in segments in patients with pronounced severe sacral tilt.
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Affiliation(s)
- Shengru Wang
- Department of Orthopedics, Peking Union Medical College Hospital, Beijing, China
| | - Jianguo Zhang
- Department of Orthopedics, Peking Union Medical College Hospital, Beijing, China
| | - Yanbin Zhang
- Department of Orthopedics, Beijing Jishuitan Hospital, Beijing, China
| | - You Du
- Department of Orthopedics, Peking Union Medical College Hospital, Beijing, China
| | - Yang Yang
- Department of Orthopedics, Peking Union Medical College Hospital, Beijing, China
| | - Guanfeng Lin
- Department of Orthopedics, Peking Union Medical College Hospital, Beijing, 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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Compressive Myelopathy in Congenital Kyphosis of the Upper Thoracic Spine: A Retrospective Study of 6 Cases. Clin Spine Surg 2017; 30:E1098-E1103. [PMID: 28937466 DOI: 10.1097/bsd.0000000000000350] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN A retrospective study. OBJECTIVE The goal of this retrospective study was to describe the uncommon presentation of neurological deficits in patients with congenital kyphosis of the upper thoracic spine (T1-T4). SUMMARY OF BACKGROUND DATA Congenital kyphosis is an uncommon deformity but can potentially lead to spinal cord compression and paraplegia, particularly in type I (failure of formation) deformities. Few reports have described compressive myelopathy associated with congenital kyphosis of the upper thoracic spine. METHODS Six patients with congenital kyphosis of the upper thoracic spine, including 2 adults and 4 pediatric patients, developed progressive or sudden onset of paraplegia. Angles of kyphosis ranged from 75 to 120 degrees. Magnetic resonance imaging demonstrated spinal cord thinning and compression at the kyphotic apex in all patients. All patients underwent decompressive and correctional surgery by single-stage posterior vertebral column resection or 2-stage anterior corpectomy fusion and posterior fixation. Neurological status was evaluated using the ASIA impairment classification and the motor score. RESULTS Postoperatively, all patients had 25%-80% correction of kyphosis. All patients improved neurologically between 0 and 2 ASIA scales after surgery. Among them, an adolescent patient presenting as acute ASIA A improved to ASIA E within 1 year after surgery. Another adolescent patient deteriorated from preoperative ASIA C to ASIA A in the immediate postoperative period but improved to ASIA D within 1 year after surgery. CONCLUSIONS Congenital kyphosis of the upper thoracic spine has a high incidence of compressive myelopathy. Duration from onset of paraplegia to surgical intervention and severity of preoperative paraplegia are 2 key factors in determining neurological prognosis after surgery.
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Liu S, Zhang N, Song Y, Song Z, Zhang L, Liu J, Xie E, Wu Q, Hao D. Radiologic comparison of posterior release, internal distraction, final PSO and spinal fusion with one-stage posterior vertebral column resection for multi-level severe congenital scoliosis. BMC Musculoskelet Disord 2017. [PMID: 28633648 PMCID: PMC5477743 DOI: 10.1186/s12891-017-1627-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background To compare radiologic results of posterior release, internal distraction, and final pedicle subtraction osteotomy (PSO) and spinal fusionwith one-stage posterior vertebral column resection (PVCR) in treating multi-level severe congenital scoliosis. Methods Forty-onesevere congenital scoliosis patients were used in the study. Group A comprised 24 patients who underwent one-stage PVCR. Group B comprised 17 patients who underwent posterior release with internal distraction, followed by final posterior fusion and instrumentation. The average preoperative main curve was 110.4° (95–130°) in group A and 109.4° (range 90°–126°) in group B. Postoperative follow-up time was ≥2 years (2.0–4.5 years) to analyze the radiographic and clinical outcomes. Results A comparison of posterior release, internal distraction, and final spinal fusion with PVCR showed no significant differences in postoperative main curve and compensatory caudal curve correction, coronal and sagittal imbalance. However, significant differences were found between the 2 groups in compensatory cranial curve correction. Conclusions Posterior release, internal distraction, and final spinal fusion produce better corrective results in compensatory cranial curve correction than PVCR in treating severe multi-level congenital scoliosis.
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Affiliation(s)
- Shichang Liu
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, South door slightly Friendship Road 555, Xi'an, 710000, People's Republic of China
| | - Nannan Zhang
- National Center for Birth Defect Monitoring, West China Second University Hospital, Sichuan University and Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, 610041, People's Republic of China
| | - Yueming Song
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Zongrang Song
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, South door slightly Friendship Road 555, Xi'an, 710000, People's Republic of China.
| | - Liping Zhang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, South door slightly Friendship Road 555, Xi'an, 710000, People's Republic of China
| | - Jijun Liu
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, South door slightly Friendship Road 555, Xi'an, 710000, People's Republic of China
| | - En Xie
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, South door slightly Friendship Road 555, Xi'an, 710000, People's Republic of China
| | - Qining Wu
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, South door slightly Friendship Road 555, Xi'an, 710000, People's Republic of China
| | - Dingjun Hao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, South door slightly Friendship Road 555, Xi'an, 710000, People's Republic of China
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Piantoni L, Francheri Wilson IA, Tello CA, Noel MA, Galaretto E, Remondino RG, Bersusky ES. Hemivertebra Resection With Instrumented Fusion by Posterior Approach in Children. Spine Deform 2015; 3:541-548. [PMID: 27927556 DOI: 10.1016/j.jspd.2015.04.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 03/13/2015] [Accepted: 04/26/2015] [Indexed: 11/15/2022]
Abstract
STUDY DESIGN We conducted a retrospective study of patients with congenital scoliosis due to hemivertebra (HV) and performed resection with instrumentation through posterior approach-only with long term follow-up. OBJECTIVES The objective of this study was to assess results of HV resection by posterior approach-only with instrumentation between 2002 and 2011. SUMMARY AND BACKGROUND DATA Hemiepiphysiodesis, arthrodesis in situ and resection without instrumentation had been performed in the past with different results. Hemivertebra resection with spinal instrumentation through anterior and posterior approach has been advocated as the treatment of choice. METHODS A total of 67 patients with 78 HV and 70 surgical procedures were evaluated. Thirty-five of the patients were females and 32 were males. The mean age of the patients was 5.5 years (from 0.8 to 16 yr), and the mean follow-up period was 6.55 years (from 2.1 to 10.8 yr). Eighteen patients presented additional pathologies: specific syndromes, cardiopathies, thoracic, abdominal, and bone malformations. Sixteen patients had partial HV while 51 had full mobility HV. Twenty-eight of the HV were thoracic, 16 thoracolumbar, 28 lumbar, and six lumbosacral. RESULTS The scoliosis mean preoperative angular value was 38.55°, and the mean postoperative angular value was 19.89°. The kyphosis mean preoperative angular value was 29.98° and the mean postoperative angular value was 15.41°. One rod was used in 38 surgical procedures (54.28%) and 2 rods in 32 procedures (45.72%). We used monoaxial screws in 45 patients, poliaxial screws in 17 patients, and both monoaxial screws and poliaxial screws in one patient. Screws and hooks were used in one patient and hooks in three patients. Arthrodesis was performed in 64 patients, and no complications were registered in those without arthrodesis. Postoperative orthesis was used in 57 opportunities. Several complications during or after HV resection by posterior approach-only were reported. Two patients suffered from intraoperative neurophysiological complications, which were resolved during surgery with minimum gestures and presented no sequelae. Two patients developed superficial infections and needed toilette and IV antibiotic therapy. Two patients needed an additional surgery due to secondary curves, 4.9 yr after primary surgery on average. One patient developed crankshaft. CONCLUSIONS We concluded that HV resection by posterior approach-only with instrumentation is a simple, secure, reliable, less invasive and well tolerated technique that can successfully resolve this kind of congenital scoliosis in children.
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Affiliation(s)
- Lucas Piantoni
- Servicio de Patología Espinal, Hospital Nacional de Pediatría, Prof. Dr. Juan P. Garrahan C.A.B.A., Buenos Aires, Argentina.
| | - Ida A Francheri Wilson
- Servicio de Patología Espinal, Hospital Nacional de Pediatría, Prof. Dr. Juan P. Garrahan C.A.B.A., Buenos Aires, Argentina
| | - Carlos A Tello
- Servicio de Patología Espinal, Hospital Nacional de Pediatría, Prof. Dr. Juan P. Garrahan C.A.B.A., Buenos Aires, Argentina
| | - Mariano A Noel
- Servicio de Patología Espinal, Hospital Nacional de Pediatría, Prof. Dr. Juan P. Garrahan C.A.B.A., Buenos Aires, Argentina
| | - Eduardo Galaretto
- Servicio de Patología Espinal, Hospital Nacional de Pediatría, Prof. Dr. Juan P. Garrahan C.A.B.A., Buenos Aires, Argentina
| | - Rodrigo G Remondino
- Servicio de Patología Espinal, Hospital Nacional de Pediatría, Prof. Dr. Juan P. Garrahan C.A.B.A., Buenos Aires, Argentina
| | - Ernesto S Bersusky
- Servicio de Patología Espinal, Hospital Nacional de Pediatría, Prof. Dr. Juan P. Garrahan C.A.B.A., Buenos Aires, Argentina
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Crostelli M, Mazza O, Mariani M. Posterior approach lumbar and thoracolumbar hemivertebra resection in congenital scoliosis in children under 10 years of age: results with 3 years mean follow up. 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 2014; 23:209-15. [PMID: 23934348 PMCID: PMC3897828 DOI: 10.1007/s00586-013-2933-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Revised: 03/28/2013] [Accepted: 07/25/2013] [Indexed: 11/25/2022]
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.
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Affiliation(s)
- Marco Crostelli
- Spine Disease Unit, Ospedale Pediatrico Bambino Gesù Roma-Palidoro, Via Torre di Palidoro, Rome, Italy,
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Zhou C, Liu L, Song Y, Liu H, Li T, Gong Q, Zeng J, Kong Q. Hemivertebrae resection for unbalanced multiple hemivertebrae: is it worth it? 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 2013; 23:536-42. [PMID: 24162520 DOI: 10.1007/s00586-013-3065-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 08/29/2013] [Accepted: 10/09/2013] [Indexed: 02/05/2023]
Abstract
PURPOSE To assess the correction effect of hemivertebra resection for unbalanced multiple hemivertebrae by measuring corresponding parameters in both coronal and sagittal planes on series posteroanterior and lateral radiographs and report the related complications. METHODS Twelve children with unbalanced multiple hemivertebrae were operated on by hemivertebra resection through a combined anterior and posterior approach or a posterior-only procedure. Mean age at time of surgery was 9.8 years (range 2-14 years). They were retrospectively studied with a mean follow-up of 48.7 months (range 30-60 months). RESULTS The mean Cobb angle of the main curve was 65.3° (range 45°-92°) before surgery and 13.8° (range 4°-30°) at the last follow-up. The correction rate was 80.0% (range 65.5-92.4 %). The compensatory cranial curve was corrected from 25.8° (range 5°-53°) to 11.7° (range 0°-34°) with a correction rate of 65.9% (range 33.3-100%), and the compensatory caudal curve was corrected from 32.4° (range 17°-57°) to 7.1° (range 0°-20°) with a correction rate of 81.4% (range 53.1-100%). The angle of segmental kyphosis was 41.3° (range 12°-76°) before surgery and 17.0° (range -12° to 45°) at the final follow-up. The coronal imbalance was -1.0 cm (range -3.5 to 3 cm) before surgery and 0.0 cm (range -1.0 to 1.5 cm) at the most recent follow-up. The sagittal imbalance was 0.9 cm (range -3.2 to 3 cm) before surgery and 0.6 cm (range -3.0 to 3.5 cm) at the most recent follow-up. Complications including pedicle fractures, and pseudarthrosis were found in two patients (20 %). CONCLUSIONS In the patients with unbalanced multiple hemivertebrae, hemivertebra resection allows for excellent correction in both the coronal and sagittal planes, and great care should be taken to reduce the rate of complications.
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Affiliation(s)
- Chunguang Zhou
- Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
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Jeszenszky D, Fekete TF, Kleinstueck FS, Haschtmann D, Bognár L. Fusionless posterior hemivertebra resection in a 2-year-old child with 16 years follow-up. 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 2012; 21:1471-6. [PMID: 22349966 DOI: 10.1007/s00586-012-2152-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Accepted: 01/04/2012] [Indexed: 11/29/2022]
Abstract
PURPOSE We present the case of a 2-year-old patient with congenital scoliosis due to a lumbar hemivertebra. The current gold standard treatment of such an abnormality would be hemivertebra resection and short level posterior spinal fusion. However, due to the young age of the patient, we considered that application of a fusionless solution might offer advantages in terms of retaining normal segmental motion and the potential for growth. METHODS The incarcerated hemivertebra was resected and the facet joints of the neighbouring vertebrae were joined to create a new functional motion segment and correct the kyphoscoliotic deformity. Transpedicular screws were inserted on the convex side in L2 and L3 and a tension band was applied. RESULTS 16 years after the surgery, the patient was completely pain-free, motion of the lumbar spine was preserved and the physiological curvatures were maintained. CONCLUSION To our knowledge a fusionless surgical solution for the treatment of a hemivertebra has never been described before. Although this is only a single case, the good result with a long follow-up suggests the technique is worthwhile considering when planning the treatment of a lumbar hemivertebra in very young children.
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Affiliation(s)
- D Jeszenszky
- Spine Unit, Schulthess Clinic, Zurich, Switzerland
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Chatterjee AD, Hassan K, Grevitt MP. Congenital kypho-scoliosis: a case of thoracic insufficiency syndrome and the limitations of treatment. 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 2011; 21:1043-9. [PMID: 22048403 DOI: 10.1007/s00586-011-2032-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Revised: 07/03/2011] [Accepted: 09/16/2011] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Congenital spinal vertebral anomalies may present with deformity resulting in congenital scoliosis and kyphosis. This leads to abnormal spinal growth. The latter when combined with associated rib fusions may impair normal thoracic cage development and resultant pulmonary hypoplasia. Most congenital scoliosis can be detected in utero by ultrasound scan or recognized in the neonatal period, but a few spinal defects can remain undetected. MATERIALS AND METHODS In this Grand Round, we present the case of a 7-year-old girl with a severe scoliosis and thoracic insufficiency syndrome (TIS). 3D CT reconstruction imaging demonstrated a mixed picture of fusion and segmentation abnormalities. A marked kyphoscoliosis was demonstrated at the thoraco-lumbar junction. Via a left thoracotomy, anterior excision of intervertebral discs was performed together with, interbody fusion, and in situ stabilisation of the kyphosis with double allograft (femur) strut grafts. CONCLUSIONS This article highlights the features of congenital kypho-scoliosis and TIS. The difficulties of treating kyphosis when combined with TIS are discussed together with the limitations of current surgical techniques.
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Affiliation(s)
- A D Chatterjee
- Centre for Spinal Studies and Surgery, Queens Medical Centre, Derby Road, Nottingham, UK.
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Lamartina C, Berjano P. Paraplegia after posterior only correction of congenital kyphosis. 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 2011; 20:1582-3. [PMID: 21822663 DOI: 10.1007/s00586-011-1942-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Halm H. Transpedicular hemivertebra resection and instrumented fusion for congenital scoliosis. 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 2011; 20:993-4. [PMID: 21541669 DOI: 10.1007/s00586-011-1806-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Indexed: 11/29/2022]
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Li XF, Liu ZD, Hu GY, Chen B, Zhong GB, Zang WP, Wang HT. Posterior unilateral pedicle subtraction osteotomy of hemivertebra for correction of the adolescent congenital spinal deformity. Spine J 2011; 11:111-8. [PMID: 20951097 DOI: 10.1016/j.spinee.2010.08.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Accepted: 08/27/2010] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The treatment of adolescent congenital deformity (late-diagnosed congenital deformity) is still unknown. The best candidates for hemivertebra excision are young patients, typically between 4 and 6 years of age. Partial excision may be feasible for older children. PURPOSE The purpose of this study was to assess the effect of unilateral pedicle subtraction osteotomy of hemivertebra for correction of the adolescent congenital spinal deformity. STUDY DESIGN Retrospective analysis. PATIENT SAMPLE Twelve patients with adolescent congenital deformity who underwent posterior unilateral pedicle subtraction osteotomy and correction were evaluated. Mean age at the time of surgery was 17 years. OUTCOME MEASURES The charts, standing full-length posteroanterior and lateral view radiographs, and functional measures were reviewed. METHODS For evaluation of surgical effectiveness, comparative analysis of the parameters of the total main curve, the segmental curve, the compensatory cranial and caudal curves, the segmental kyphosis, and the trunk shift before and after operation and at the most recent follow-up was done. RESULTS The mean follow-up period was 40.5 months. Mean Cobb angles of the total main curve and the segmental curve were, respectively, 47.5° and 43.8° before surgery, 23.7° and 16.5° after surgery, and 22.6° and 17° at the last follow-up. The angle of segmental kyphosis was 11.8° before surgery, 6.2° after surgery, and 7.8° (range, -30° to 26°) at the final follow-up. The mean final global lordosis was within the normal range. No neurologic deficit occurred. Solid fusion was achieved for all cases. CONCLUSIONS Unilateral pedicle subtraction osteotomy with instrumentation from a posterior-only approach is indicated in older teenagers for an adolescent congenital spinal deformity. Compared with hemivertebra excision, corrective surgery with hemivertebra osteotomy has a lower intraoperative blood loss and shorter operation time.
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Affiliation(s)
- Xin-Feng Li
- Department of Orthopaedic Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
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Abstract
Congenital spinal vertebral anomalies can present as scoliosis or kyphosis or both. The worldwide prevalence of the vertebral anomalies is 0.5-1 per 1000 live births. Vertebral anomalies can range from hemi vertebrae (HV) which may be single or multiple, vertebral bar with or without HV, block vertebrae, wedge shaped or butterfly vertebrae. Seventy per cent of congenital vertebral anomalies result in progressive deformities. The risk factors for progression include: type of defect, site of defect (junctional regions) and patient's age at the time of diagnosis. The key to success in managing these spinal deformities is early diagnosis and anticipation of progression. One must intervene surgically to halt the progression of deformity and prevent further complications associated with progressive deformity. Planning for surgery includes a preoperative MRI scan to rule out spinal anomalies such as diastematomyelia. The goals of surgical treatment for congenital spinal deformity are to achieve a straight growing spine, a normal standing sagittal profile, and a short fusion segment. The options of surgery include in situ fusion, convex hemi epiphysiodesis and hemi vertebra excision. These basic surgical procedures can be combined with curve correction, instrumentation and short segment fusion. Most surgeons prefer posterior (only) surgery for uncomplicated HV excision and short segment fusion. These surgical procedures can be performed through posterior, anterior or combined approaches. The advocates of combined approaches suggest greater deformity correction possibilities with reduced incidence of pseudoarthrosis and minimize crankshaft phenomenon. We recommend posterior surgery for curves involving only an element of kyphosis or modest deformity, whereas combined anterior and posterior approach is indicated for large or lordotic deformities. In the last decade, the use of growing rods and vertebral expandable prosthetic titanium rib has improved the armamentarium of the spinal surgeon in dealing with certain difficult congenital spinal deformities. The goal of growing rod treatment is to provide simultaneous deformity correction and allow for continued spinal growth. Once maximal spinal growth has been achieved, definitive fusion and instrumentation is performed.
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Affiliation(s)
- Ujjwal K Debnath
- The Centre for Spinal Studies & Surgery, Queens Medical Centre, University Hospital, Nottingham, NG7 2UH, UK
| | - Vivek Goel
- The Centre for Spinal Studies & Surgery, Queens Medical Centre, University Hospital, Nottingham, NG7 2UH, UK
| | - Nanjanduppa Harshavardhana
- The Centre for Spinal Studies & Surgery, Queens Medical Centre, University Hospital, Nottingham, NG7 2UH, UK
| | - John K Webb
- The Centre for Spinal Studies & Surgery, Queens Medical Centre, University Hospital, Nottingham, NG7 2UH, UK
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Ocampo GA, Ferreyra AC, Contreras SP, Leighton MC. Resección de hemivértebra con técnica de eggshell en cifoescoliosis congénita: resultados en niños entre uno y siete años. COLUNA/COLUMNA 2009. [DOI: 10.1590/s1808-18512009000300016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCCIÓN: La hemivértebra es la causa de 50% de las cifoescoliosis congénitas y en general requiere tratamiento quirúrgico. OBJETIVO: evaluar los resultados clínicos y radiológicos de la resección de hemivértebra con técnica de eggshell en niños entre uno y siete años. DISEÑO DEL ESTUDIO: análisis retrospectivo de pacientes sometidos a resección de hemivértebra con técnica de eggshell. MÉTODOS: entre Enero del 2006 y Junio del 2008, siete hemivértebras fueron resecadas en siete pacientes consecutivos, entre uno y siete años de edad. Se revisó retrospectivamente las fichas clínicas y radiografías. La edad promedio al momento de la cirugía fue 3,2 años (rango de uno a siete años) y el seguimiento promedio fue de 17 meses (rango 7 a 35 meses). Se registró ángulo de Cobb de la escoliosis y cifosis en el preoperatorio y al término del seguimiento, tiempo operatorio, transfusión de glóbulos rojos y complicaciones. RESULTADOS: el ángulo preoperatorio promedio de la escoliosis fue 35° y 19° al término del seguimiento, con un 40% de corrección. El ángulo preoperatorio promedio de la cifosis fue 42° y 25° al término del seguimiento, con un 33% de corrección. Cuatro pacientes necesitaron transfusión de glóbulos rojos, promedio 1,25 unidades. El tiempo quirúrgico promedio fue 225 minutos. Dos pacientes presentaron complicaciones, una rotura dural y una fractura pedicular. No se presentaron complicaciones neurológicas. Todos los pacientes presentaban fusión sólida al término del seguimiento. CONCLUSIÓN: la resección de hemivértebra con técnica de eggshell es un procedimiento seguro, que permite una excelente e inmediata corrección de la cifoescoliosis congénita, la que se mantiene en el corto plazo.
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