Effects of posterior hemivertebra resection and short segment fusion on the evolution of sagittal balance in children with congenital scoliosis

Sagittal Spinal Profile in Patients with Lumbosacral Hemivertebra: Preoperative Status and Postoperative Evolution at a Mean Follow-up of 7.5 Years

BACKGROUND

A lumbosacral hemivertebra (LSHV) presents a complex challenge in treating congenital scoliosis. Previous studies have proven the effectiveness of posterior LSHV resection. However, they have primarily focused on coronal balance, neglecting the sagittal alignment, which is crucial for spinal function. The aim of this retrospective study was to assess preoperative sagittal imbalance in patients with an LSHV and to evaluate the evolution of sagittal alignment following posterior hemivertebra resection and short-segment fusion.

METHODS

A retrospective analysis was performed that included 58 patients with LSHV who underwent posterior LSHV resection between 2010 and 2020 and had a mean follow-up duration of 7.5 years. All patients were Han Chinese, and 30 of the 58 patients were female. The mean age was 7.3 years. Sagittal balance parameters were measured preoperatively and at multiple postoperative time points. Clinical outcomes were assessed with use of the Scoliosis Research Society (SRS)-22 questionnaire.

RESULTS

Preoperatively, 60.3% of patients presented with sagittal imbalance (defined as a sagittal vertical axis [SVA] of >20 mm). Postoperatively, the mean SVA significantly improved, decreasing to <20 mm at the 1-year follow-up (p = 0.016). The pelvic incidence-lumbar lordosis mismatch (PI-LL) also showed significant improvement at the immediate postoperative time point (p = 0.012) and at the last follow-up (p = 0.013). Patients who underwent anterior column reconstruction demonstrated better postoperative global sagittal balance than those who did not (SVA, p = 0.015; PI-LL, p < 0.001). SRS-22 total, self-image, and satisfaction scores significantly (p < 0.001) improved postoperatively.

CONCLUSIONS

This study highlighted the prevalence of preoperative sagittal imbalance in patients with an LSHV and emphasized the impact of LSHV resection (particularly when accompanied by anterior column reconstruction) in achieving postoperative sagittal balance and in enhancing patient quality of life during the long-term follow-up period.

LEVEL OF EVIDENCE

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Preliminary study assessing the long-term surgical outcomes of TBX6-associated congenital scoliosis (TACS) patients using the propensity score matching method: exploring the clinical implications of genetic discoveries in congenital scoliosis

BACKGROUND

Compound inheritance of TBX6 accounts for approximately 10% of sporadic congenital scoliosis (CS) cases. Such cases are called TBX6-associated congenital scoliosis (TACS). TACS has been reported to have certain common clinical phenotypes. However, whether the surgical outcomes of TACS patients differ from those of other CS patients remains unclear.

METHODS

We retrospectively searched for patients who were diagnosed with scoliosis. TACS was identified in genetic testing for CS. After propensity score matching, patients with TACS were matched with patients with NTACS according to sex, age, main curvature, classification, deformity location, surgical methods, fusion segment and number of fusions. We evaluated and compared the coronal and sagittal radiographic parameters before surgery, immediately after surgery, and at the final follow-up. Surgical information, including surgical method, fusion segment, blood loss and complications, was also compared and analyzed.

RESULTS

Twenty-eight TACS patients were propensity score matched with 28 NTACS patients among 473 CS patients. The preoperative matching parameters mentioned in the Methods section were similar between the TACS group and the NTACS group. In the TACS group, the correction rate of the cranial compensatory curve (64.9 ± 18.6% vs. 51.2 ± 24.0%, P = 0.014) and the correction rate of the caudal compensatory curve (77.4 ± 12.5% vs. 65.4 ± 22.7%, P = 0.011) were significantly greater than those in the NTACS group, and the loss rate of correction of the cranial compensatory curve in the TACS group (0.6 ± 19.2% vs. 26.7 ± 50.8, P = 0.002) was significantly lower than that in the NTACS group. The total complication rate (7.2% vs. 14.3%) and incidence of adding-on (0 vs. 7.1%) were lower in the TACS group than in the NTACS group. There were no significant differences between the two groups in terms of blood loss, revision rate, other correction parameters, balance parameters or incidence of complications.

CONCLUSIONS

TACS patients had better surgical outcomes than NTACS patients, which means that genetic diagnosis of the TBX6 gene mutation in CS before surgery can help predict better surgical outcomes. The specific genetic mechanism is not yet clear and may be related to the relatively normal development of paravertebral tissues in TACS patients. Further research is needed.

LEVEL OF EVIDENCE

Leve: III.

Diagnosis and treatment of congenital scoliosis

Background: Congenital scoliosis is caused by anomalies of the vertebra, such as hemivertebra or unsegmented bar, which result in asymmetric growth of the spine. The disruption of vertebra development during embryogenesis may be accompanied by other congenital multi-organ anomalies. The progression of the scoliotic curve may also hinder the development of other organs.Current Concepts: Hemivertebra excision and short spinal fusion have demonstrated favorable outcomes. However, the need for spinal growth and lung development has led to new treatment modalities. Growth-friendly surgeries, such as with a growing rod or vertical expandable rib-based distraction device, have demonstrated good results with curve correction while maintaining spinal growth. Although the outcome of conservative treatment for congenital scoliosis is questionable, casting may be effective as a “time-buying strategy” to delay the need for surgery.Discussion and Conclusion: It is essential to decide on a treatment plan considering the progression of the curve and growth of the spine and lungs through an individualized approach.