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Zhiguo Z, Fan L, Yuanxue L, Xing W, Si W, Ruichen L. Minimally invasive spine surgery strategy for congenital cervicothoracic scoliosis in children: Less blood loss and shortened segmental fusions/fewer pedical screws. Front Surg 2023; 10:1137675. [PMID: 37035570 PMCID: PMC10076645 DOI: 10.3389/fsurg.2023.1137675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/06/2023] [Indexed: 04/11/2023] Open
Abstract
Objective To explore the feasibility of a minimally invasive spine surgery strategy for congenital cervicothoracic scoliosis. Materials and methods From April 2022 to August 2022 in the hospital, three patients with torticollis and/or shoulder imbalance due to a cervicothoracic hemivertebra were performed on by hemivertebra resection and short fusion of the adjacent vertebrae. Resection was operated by a posterior approach. The average age of three patients of surgery was 8 years 2 months and the mean follow-up period was 6 months. Radiographic assessments and cosmetic outcomes were documented on changes in measurements of segmental scoliosis, neck tilt, head shift, shoulder balance, and sagittal profiles. Results The mean operating time of the procedure was 283 min and the instrumentation density was 1.5 pedicle screws per vertebra. The mean estimated blood loss was 257 ml, which was 20% less than the data described in various literatures. The mean segmental Cobb angle at the cervicothoracic deformity was 35.9° before surgery, 20.7° after surgery, and 16.3° at the latest follow-up, with a correction rate of 54.59%. Neck tilt decreased from 17.3° before surgery to 14.3° after surgery, and 11.7° at the latest follow-up, with a correction rate of 32.37%. T1 tilt improved from 16.5° before surgery to 12.9° after surgery, and 7.6° at the latest follow-up, with a correction rate of 53.94%. The clavicle angle improved from 4.8° before surgery to 3.1° after surgery, and 1.9° at the latest follow-up, with a correction rate of 60.42%. Head shift improved from 21.4 mm before surgery to 9.2 mm after surgery, and 12.3 mm at the latest follow-up, with a correction rate of 42.52%. The correction of torticollis and shoulder asymmetry was achieved in all cases. Conclusions Minimally invasive spine surgery strategy may be an option for congenital cervicothoracic scoliosis. A good correction of cervicothoracic dissymmetry is achieved, accompanied by fewer pedicle screws and less blood loss. By deliberate operation in young kids, surgical intervention for severe compensatory curves can be prevented.
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Affiliation(s)
- Zhou Zhiguo
- Department of Orthopedics, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, HUST, Wuhan, China
- Correspondence: Zhou Zhiguo
| | - Liu Fan
- Department of Rheumatology, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, HUST, Wuhan, China
| | - Lei Yuanxue
- Department of Orthopedics, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, HUST, Wuhan, China
| | - Wu Xing
- Department of Orthopedics, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, HUST, Wuhan, China
| | - Wang Si
- Department of Orthopedics, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, HUST, Wuhan, China
| | - Li Ruichen
- Department of Orthopedics, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, HUST, Wuhan, China
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Gomez JA, Ge DH, Boden E, Hanstein R, Alvandi LM, Lo Y, Hwang S, Samdani AF, Sponseller PD, Garg S, Skaggs DL, Vitale MG, Emans J. Posterior-only Resection of Single Hemivertebrae With 2-Level Versus >2-Level Fusion: Can We Improve Outcomes? J Pediatr Orthop 2022; 42:354-360. [PMID: 35499167 DOI: 10.1097/bpo.0000000000002165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The outcomes of congenital scoliosis (CS) patients undergoing hemivertebra (HV) resection surgery with a 2-level fusion versus a >2-level fusion are unclear. We hypothesized that CS patients undergoing HV resection and a >2-level fusion have decreased curve progression and reoperation rates compared with 2-level fusions. METHODS Retrospective review of prospectively collected data from a multicenter scoliosis database. Fifty-three CS patients (average age 4.5, range 1.2 to 10.9 y) at index surgery were included. Radiographic and surgical parameters, complications, as well as revision surgery rates were tracked at a minimum of 2-year follow-up. RESULTS Twenty-six patients had a 2-level fusion while 27 patients had a >2-level fusion with similar age and body mass index between groups. The HV was located in the lumbar spine for 69% (18/26) 2-level fusions and 30% (8/27) >2-level fusions ( P =0.006). Segmental HV scoliosis curve was smaller in 2-level fusions compared to >2-level fusions preoperatively (38 vs. 50 degrees, P =0.016) and at follow-up (25 vs. 34 degrees, P =0.038). Preoperative T2-T12 (28 vs. 41 degrees, P =0.013) and segmental kyphosis (11 vs. 23 degrees, P =0.046) were smaller in 2-level fusions, but did not differ significantly at postoperative follow-up (32 vs. 39 degrees, P =0.22; 13 vs. 11 degrees, P =0.64, respectively). Furthermore, the 2 groups did not significantly differ in terms of surgical complications (27% vs. 22%, P =0.69; 2-level fusion vs. >2-level fusion, respectively), unplanned revision surgery rate (23% vs. 22%, 0.94), growing rod placement or extension of spinal fusion (15% vs. 15%, P =0.95), or health-related quality of life per the EOS-Questionnaire 24 (EOSQ-24). Comparison of patients with or without the need for growing rod placement or posterior spinal fusion revealed no significant differences in all parameters analyzed. CONCLUSIONS Two-level and >2-level fusions can control congenital curves successfully. No differences existed in curve correction, proximal junctional kyphosis or complications between short and long-level fusion after HV resection. Both short and long level fusions are viable options and generate similar risk of revision. The decision should be individualized by patient and surgeon.
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Affiliation(s)
- Jaime A Gomez
- Department of Orthopaedic Surgery, Montefiore Medical Center
| | - David H Ge
- Department of Orthopaedic Surgery, Montefiore Medical Center
| | - Emma Boden
- Department of Orthopaedic Surgery, Montefiore Medical Center
| | - Regina Hanstein
- Department of Orthopaedic Surgery, Montefiore Medical Center
| | - Leila Mehraban Alvandi
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx
| | - Yungtai Lo
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx
| | | | | | - Paul D Sponseller
- Departments of Orthopaedic Surgery and Anesthesiology, The Johns Hopkins University, Baltimore, MD
| | | | - David L Skaggs
- Department of Orthopaedics, Cedars-Sinai, Los Angeles, CA
| | - Michael G Vitale
- Columbia University Medical Center/Morgan Stanley Children's Hospital, New York, NY
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Nadirov N, Vissarionov S, Filippova A, Kokushin D, Sazonov V. The results of surgical treatment of preschool and primary school age children with congenital deformation of the spine in isolated hemivertebra: Comparative analysis. Front Pediatr 2022; 10:960209. [PMID: 36160786 PMCID: PMC9500183 DOI: 10.3389/fped.2022.960209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/23/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Despite a detailed study of the natural development of congenital spinal deformity in an isolated hemivertebra and the methods of surgical correction of this pathology, some issues remain unresolved. The age at which the surgical correction of congenital spinal deformity should be performed is a controversial issue among specialists dealing with this problem. The aim of the work was to conduct a comparative analysis of the results of spinal deformity correction in children with congenital kyphoscoliosis with an isolated hemivertebra of preschool and primary school age. MATERIALS AND METHODS The study involved 26 patients aged from 1 year 9 months to 9 years 6 months (10 girls and 16 boys) with congenital kyphoscoliosis caused by an isolated hemivertebra. The patients underwent surgical interventions of partial or complete resection of the hemivertebra with adjacent intervertebral discs from the dorsal or combined approach, correction, and stabilization of congenital deformity of the spine with a posterior multi-support metal structure. All the patients were divided into two groups by age: the first group-children under 4 years old (14 children), and the second group-children of 6 years and older (12 children). RESULTS Metal fixation during surgical treatment in children of primary school and preschool ages was carried out in the majority of cases in a polysegmental manner. Regarding the approach for surgical treatment, it can be noted that in the 2nd group of patients, preference was more often given to the dorsal surgical approach. The duration of the surgical intervention and the amount of blood loss between different age groups did not have statistically significant differences. In the group of children of preschool age, in three cases, the destabilization of the metal structure was noted in the early postoperative period when control radiographs were performed after surgical treatment. In the group of older children, after surgical treatment, the spinal dysplastic deformity above or below the zone of metal fixation was detected in three cases. CONCLUSION The effectiveness of surgical treatment of congenital deformity was significantly higher in children of the younger age group compared to school-age patients.
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Affiliation(s)
- Nurbek Nadirov
- Mother and Child Health Center, Department of Orthopedics, University Medical Center, Nur-Sultan, Kazakhstan
| | - Sergey Vissarionov
- G. Turner National Medical Research Center for Children's Orthopedics and Trauma Surgery, Ministry of Health of the Russian Federation, Saint Petersburg, Russia
| | - Alexandra Filippova
- G. Turner National Medical Research Center for Children's Orthopedics and Trauma Surgery, Ministry of Health of the Russian Federation, Saint Petersburg, Russia
| | - Dmitriy Kokushin
- G. Turner National Medical Research Center for Children's Orthopedics and Trauma Surgery, Ministry of Health of the Russian Federation, Saint Petersburg, Russia
| | - Vitaliy Sazonov
- Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Nur-Sultan, Kazakhstan
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Bixby EC, Skaggs K, Marciano GF, Simhon ME, Menger RP, Anderson RCE, Vitale MG. Resection of congenital hemivertebra in pediatric scoliosis: the experience of a two-specialty surgical team. J Neurosurg Pediatr 2021; 28:250-259. [PMID: 34214975 DOI: 10.3171/2020.12.peds20783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/07/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Institutions investigating value and quality emphasize utilization of two attending surgeons with different areas of technical expertise to treat complex surgical cases and to minimize complications. Here, the authors chronicle the 12-year experience of using a two-attending surgeon, two-specialty model to perform hemivertebra resection in the pediatric population. METHODS Retrospective cohort data from 2008 to 2019 were obtained from the NewYork-Presbyterian Morgan Stanley Children's Hospital operative database. This database included all consecutive pediatric patients < 21 years old who underwent hemivertebra resection performed with the two-attending surgeon (neurosurgeon and orthopedic surgeon) model. Demographic information was extracted. Intraoperative complications, including durotomy and direct neurological injury, were queried from the clinical records. Intraoperative neuromonitoring data were evaluated. Postoperative complications were queried, and length of follow-up was determined from the clinical records. RESULTS From 2008 to 2019, 22 patients with a median (range) age of 9.1 (2.0-19.3) years underwent hemivertebra resection with the two-attending surgeon, two-specialty model. The median (range) number of levels fused was 2 (0-16). The mean (range) operative time was 5 hours and 14 minutes (2 hours and 59 minutes to 8 hours and 30 minutes), and the median (range) estimated blood loss was 325 (80-2700) ml. Navigation was used in 14% (n = 3) of patients. Neither Gardner-Wells tongs nor halo traction was used in any operation. Neuromonitoring signals significantly decreased or were lost in 14% (n = 3) of patients. At a mean ± SD (range) follow-up of 4.6 ± 3.4 (1.0-11.6) years, 31% (n = 7) of patients had a postoperative complication, including 2 instances of proximal junctional kyphosis, 2 instances of distal junctional kyphosis, 2 wound complications, 1 instance of pseudoarthrosis with hardware failure, and 1 instance of screw pullout. The return to the operating room (OR) rate was 27% (n = 6), which included patients with the abovementioned wound complications, distal junctional kyphosis, pseudoarthrosis, and screw pullout, as well as a patient who required spinal fusion after loss of motor evoked potentials during index surgery. CONCLUSIONS Twenty-two patients underwent hemivertebra resection with a two-attending surgeon, two-specialty model over a 12-year period at a specialized children's hospital, with a 14% rate of change in neuromonitoring, 32% rate of nonneurological complications, and a 27% rate of unplanned return to the OR.
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Affiliation(s)
- Elise C Bixby
- 1Department of Orthopedics, Columbia University Irving Medical Center, New York, New York
| | - Kira Skaggs
- 1Department of Orthopedics, Columbia University Irving Medical Center, New York, New York
| | - Gerard F Marciano
- 1Department of Orthopedics, Columbia University Irving Medical Center, New York, New York
| | - Matthew E Simhon
- 1Department of Orthopedics, Columbia University Irving Medical Center, New York, New York
| | | | | | - Michael G Vitale
- 1Department of Orthopedics, Columbia University Irving Medical Center, New York, New York
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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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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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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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Canaz H, Canaz G, Ucar BY, Alatas I. Hemimetameric shift in spina bifida: three case reports. Childs Nerv Syst 2017; 33:535-539. [PMID: 27822764 DOI: 10.1007/s00381-016-3292-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 10/26/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Hemivertebrae is the most frequent reason of congenital scoliosis, and hemimetameric shift is a finding, which is characterized by two hemivertebraes located contralateral, with at least one normal vertebra between them. Embryologically, hemivertebrae is caused by delay in somite movements and as a result, a total vertebral shift occurs because of mismatches in the following segments. Hemimetameric shift accompanying spina bifida is described as extremely rare. There are only two case series of hemimetameric shift in literature but no spina bifida patient was reported in these series. METHODS We report three cases of hemimetameric shift with spina bifida with their detailed clinical and radiological evaluations. RESULTS Case 1 is a 3-year-old congenital scoliosis patient with tethered cord. She has mild scoliosis with a very demonstrative hemimetameric shift. Case 3 is an infant with multiple-level hemivertebrae anomalies and hemimetameric shift who had myelomeningocele closure and ventriculoperitoneal shunt installation neonatally. Case 3 is a 9-year-old male who had operated for myelomeningocele in the neonatal period. He had evident scoliosis with cervicothoracic hemimetameric shift and he is the only patient we operated for prominent scoliosis. CONCLUSIONS The present classification of hemimetameric shift was described by Kawakami et al. in 2009. It is based on development of anterior and posterior hemivertebrae segments but we think it is not suitable for patients with posterior fusion defects such as spina bifida patients. Spina bifida patients with scoliosis and hemimetameric shift are a rare but important patient group to evaluate in terms of understanding scoliosis patients with neural tube defects.
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Affiliation(s)
- Huseyin Canaz
- Department of Neurosurgery, Florence Nightingale Hospital, Istanbul Bilim University, Istanbul, Turkey
| | - Gokhan Canaz
- Department of Neurosurgery, Bakirkoy Research and Training Hospital for Neurology, Neurosurgery and Psychiatry, Bakırkoy, 34147, Istanbul, Turkey.
| | - Bekir Yavuz Ucar
- Department of Orthopaedics and Traumatology, Florence Nightingale Hospital, Istanbul Bilim University, Istanbul, Turkey
| | - Ibrahim Alatas
- Department of Neurosurgery, Florence Nightingale Hospital, Istanbul Bilim University, Istanbul, Turkey
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Guo J, Zhang J, Wang S, Wang H, Zhang Y, Yang Y, Yang X, Zhao L. Risk factors for construct/implant related complications following primary posterior hemivertebra resection: Study on 116 cases with more than 2 years' follow-up in one medical center. BMC Musculoskelet Disord 2016; 17:380. [PMID: 27589864 PMCID: PMC5010738 DOI: 10.1186/s12891-016-1229-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 08/23/2016] [Indexed: 11/25/2022] Open
Abstract
Background Posterior hemivertebra resection has become a safe and effective procedure for congenital scoliosis due to hemivertebra. However, there are still complications following primary posterior hemivertebra resection in recent reports. No risk factors associated with construct/implant related complications were identified so far. The purpose of this study is to analyze complications following primary posterior hemivertebra resection and to investigate the possible risk factors associated with construct/implant related complications in congenital scoliosis cases due to hemivertebra. Methods One hundred and sixteen congenital scoliosis cases with hemivertebra (male: female = 62:54), who underwent primary posterior hemivertebra resection from January 2003 to January 2012 in our medical center, were retrospectively evaluated in this study. Medical records were reviewed and long cassette standing spinal radiographs were measured before surgery, after surgery and at the final follow-up. Complications, including construct/implant related complications and non-construct/implant related ones, were recorded by chart review. Potential risk factors, including sex, age, segmental and main scoliosis and their correction rates, usage of cage (yes or not), fusion levels (bisegmental fusion or not), location of hemivertebra and contralateral bar/rib synostosis (with or without), were also collected. Results The mean age of initial surgery was 9.8 years old (range, 2–19 years), and the average follow-up was 67 months (range, 24–133 months). The segmental scoliosis was corrected from 34.7° ± 11.9° to 7.1° ± 5.6° post-operatively, and 9.5° ± 7.0° at the latest follow-up, with a correction rate of 79.5 %. The total main scoliosis was corrected from 43.0° ±15.6° to post-operative 11.4° ± 6.8°, and 13.9° ± 7.5° at the latest follow-up, with a mean correction rate of 73.5 %. Complications occurred in 11 out of 116 cases (9.5 %), including 7 (63.6 %) construct/implant related complications (two pedicle misplacement, one rod breakage and four implant removals due to screw dislodgement with the growth) and 4 (36.4 %) non-construct/implant related ones (one proximal adjacent kyphosis, one progressive kyphosis, and two wound non-union). Younger age (≤5 years old), lumbar hemivertebra resection, or bisegmental fusion may contribute to a higher prevalence of construct/implant related complications than other cases, although the number of cases was too small to perform statistical analysis. Conclusions The occurrence of construct/implant related complications in patients with hemivertebra resection is most likely multifactorial. Cases with younger age, bisegmental fusion, or lumbar hemivertebra may increase the risk of construct/implant related complications. Measures, such as careful preoperative evaluation and surgical plan with CT scan, sophisticated operation during surgery, usage of cage or cross-links to improve postoperative instant stability, protection in brace and regular follow-up postoperatively, should be taken to reduce construct/implant related complication rate.
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Affiliation(s)
- Jianwei Guo
- Department of Orthopedics, The Affiliated Hospital of Qingdao University, Qingdao, 266003, People's Republic of China
| | - Jianguo Zhang
- Department of Orthopedics, Peking Union Medical College Hospital, 1 Shuai Fu Yuan, Beijing, 100730, People's Republic of China.
| | - Shengru Wang
- Department of Orthopedics, Peking Union Medical College Hospital, 1 Shuai Fu Yuan, Beijing, 100730, People's Republic of China
| | - Hai Wang
- Department of Orthopedics, Peking Union Medical College Hospital, 1 Shuai Fu Yuan, Beijing, 100730, People's Republic of China
| | - Yanbin Zhang
- Department of Orthopedics, Peking Union Medical College Hospital, 1 Shuai Fu Yuan, Beijing, 100730, People's Republic of China
| | - Yang Yang
- Department of Orthopedics, Peking Union Medical College Hospital, 1 Shuai Fu Yuan, Beijing, 100730, People's Republic of China
| | - Xinyu Yang
- Department of Orthopedics, Peking Union Medical College Hospital, 1 Shuai Fu Yuan, Beijing, 100730, People's Republic of China
| | - Lijuan Zhao
- Department of Orthopedics, Peking Union Medical College Hospital, 1 Shuai Fu Yuan, Beijing, 100730, People's Republic of China
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Guo J, Zhang J, Wang S, Zhang Y, Yang Y, Yang X, Zhao L. Surgical outcomes and complications of posterior hemivertebra resection in children younger than 5 years old. J Orthop Surg Res 2016; 11:48. [PMID: 27113726 PMCID: PMC4845311 DOI: 10.1186/s13018-016-0381-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Accepted: 04/08/2016] [Indexed: 11/28/2022] Open
Abstract
Background There have been many reports on posterior hemivertebra resection. However, there were few articles in very young cases. This is a clinical retrospective study to evaluate the complications and efficacy of posterior hemivertebra resection in very young cases. Methods From January 2003 to January 2012, 39 consecutive cases of congenital scoliosis with hemivertebra were retrospectively investigated in our hospital, including 18 females and 21 males, aged from 21 to 65 months old (average 42.4 months). All the cases underwent posterior hemivertebra resection with transpedicular instrumentation. Clinical charts and radiographs of spine were retrospectively reviewed to record complications and outcomes postoperatively and at the latest follow-up. Results Mean operation time was 186.4 min (90–280 min) with average blood loss of 306.6 (100–700) ml. The total number of hemivertebrae resected was 43, including one hemivertebra in 35 cases and two hemivertebrae in 4 cases. The mean number of fused segments was 3.4, including 22 cases (56.4 %) with bisegmental fusion and 4 cases with mesh cage. Average follow-up period was 5.4 (3 to 11) years. There was a mean improvement rate of 83.6 % in the segmental scoliosis from 38.4° before surgery to 6.3° after operation and a mean improvement rate of 81.9 % in segmental kyphosis from 17.1° to 3.2° over the same time. The spontaneous correction rates of the compensatory cranial curve and compensatory caudal curve were 65.7 and 66.9 %, respectively. There were three complications (two cases),one pedicle fractures, one rod breakages, and one additional surgery for curve progression. Besides these, two additional surgeries (two cases) were performed to remove the instrumentation for pedicle elongation in the follow-up. There was no neurological complication. Conclusions Posterior hemivertebra resection with transpedicular instrumentation is a safe and effective procedure in very young congenital scoliosis cases. Earlier surgeries can achieve short fusion and save more mobile segments. However, complications associated with implants and spinal growth still remain major concerns.
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Affiliation(s)
- Jianwei Guo
- Department of Orthopedics, Peking Union Medical College Hospital, 1 Shuai Fu Yuan, Beijing, 100730, People's Republic of China
| | - Jianguo Zhang
- Department of Orthopedics, Peking Union Medical College Hospital, 1 Shuai Fu Yuan, Beijing, 100730, People's Republic of China.
| | - Shengru Wang
- Department of Orthopedics, Peking Union Medical College Hospital, 1 Shuai Fu Yuan, Beijing, 100730, People's Republic of China
| | - Yanbin Zhang
- Department of Orthopedics, Peking Union Medical College Hospital, 1 Shuai Fu Yuan, Beijing, 100730, People's Republic of China
| | - Yang Yang
- Department of Orthopedics, Peking Union Medical College Hospital, 1 Shuai Fu Yuan, Beijing, 100730, People's Republic of China
| | - Xinyu Yang
- Department of Orthopedics, Peking Union Medical College Hospital, 1 Shuai Fu Yuan, Beijing, 100730, People's Republic of China
| | - Lijuan Zhao
- Department of Orthopedics, Peking Union Medical College Hospital, 1 Shuai Fu Yuan, Beijing, 100730, People's Republic of China
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