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.
Access this article
We’re sorry, something doesn't seem to be working properly.
Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.
Similar content being viewed by others
References
McMaster MJ, David CV (1986) Hemivertebra as a cause of scoliosis. A study of 104 patients. JBJS B 68(4):588–595
McMaster MJ, Ohtsuka K (1982) The natural history of congenital scoliosis: a study of two hundred and fifty one patients. J Bone Jt Surg (Am) 64:1128–1147
Royle ND (1928) The operative removal of an accessory vertebra. Med J Aust 1:467–468
Bollini G, Docquier PL, Viehweger E, Launay F, Jouve JL (2006) Thoracolumbar hemivertebrae resection by double approach in a single procedure. Long term follow-up. Spine 31(15):1745–1757
Ruf M, Harms J (2003) Posterior hemivertebra resection with transpedicular instrumentation: early correction in children aged 1 to 6 years. Spine 28(18):2132–2138
Ruf M, Harms J (2002) Hemivertebra resection by posterior approach. Innovative operative technique and first results. Spine 27(10):1116–1123
Ruf M, Jensen R, Letko L, Harms J (2009) Hemivertebra resection and osteotomies in congenital spine deformity. Spine 34(17):1791–1799
Shono Y, Abumi K, Kaneda K (2001) One stage posterior hemivertebra resection and correction using segmental posterior instrumentation. Spine 26(7):752–757
Li X, Luo Z, Li X, Tao H, Du J, Wang Z (2008) Hemivertebra resection for the treatment of congenital lumbarspinal scoliosis with latero-posterior approach. Spine 33(18):2001
Galloway GM, Zamel K (2011) Neurophysiologic Intraoperative monitoring in Pediatrics. Ped Neur 44(3):161–170
Arlet V, Odent TH, Aebi M (2003) Congenital scoliosis. Eur Spine J 18(9):1255–1256
Jalanko T, Rintala R, Puisto V, Helenius I (2010) Hemivertebra resection for congenital scoliosis in young children. Comparison of clinical, radiographic, and health related quality of life outcomes between the anteroposterior and posterolateral approaches. Spine 36(1):41–49
Hedequist D, Ermans J, Proctor M (2009) Three rod technique facilitates hemivertebra wedge excision in young children through a posterior only approach. Spine 34(6):E225–E229
Cil A, Yazici M, Alanay A, Acaroglu RE, Surat A (2004) Letters to editor and Ruf M, Harms J in response. Spine 29(14):1593–1596
Papp T, Porter RW, Aspden RM (1994) The growth of the lumbar vertebral canal. Spine 19:2770–2773
Jeszenszky D (2000) Morphological changes of the spinal canal after placement of pedicle screws in newborn pigs. Scoliosis Research Society Annual Meeting
Fekete TF, Kleinstuck FS, Mannion AF, Kendik SZ, Jeszenszky D (2011) Prospective study of the effect of pedicle screw placement on development of the immature vertebra in an in vivo porcine model. Eur Spine J 20:1892–1898
Ruf M, Harms J (2002) Pedicle screw in 1 and 2-year-old children: technique, complications and effect on further growth. Spine 7:E460–E466
Aydogan M, Ozturk C, Tezner M, Mirzanli C, Karatoprak O, Hamazaoglu A (2008) Posterior vertebrectomy in Kyphosis, scoliosis and kyphoscoliosis due to hemivertebra. J Pediatr Orthop B 17(1):33–37
Zhang G, Shengru W, Qiu G, Yu B, Yipeng W, Luk DKK (2011) The efficacy and complications of posterior hemivertebra resection. Eur Spine J. Online ahead of pub
Kesling KL, Lonstein JE, Denis F, Perra JH, Schwender JD, Transfeldt EE, Winter RB (2003) The crankshaft phenomenon after posterior spinal arthrodesis for congenital scoliosis. A review of 54 patients. Spine 28(3):267–271
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
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. Eur Spine J 23, 209–215 (2014). https://doi.org/10.1007/s00586-013-2933-z
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-013-2933-z