Posterior thoracolumbar hemivertebra resection and short-segment fusion in congenital scoliosis: surgical outcomes and complications with more than 5-year follow-up

The Comparison of Partial Hemivertebrae Resection Versus Total Hemivertebrae Resection in Children With Congenital Scoliosis

BACKGROUND AND OBJECTIVES

The surgical intervention for hemivertebra removal is complex, leading to a lack of a definitive solution. We aim to compare the clinical efficacy of less invasive, partial hemivertebra resection vs total hemivertebra resection in children.

METHODS

Between 2011 and 2016, a retrospective study was conducted on a cohort of 43 patients diagnosed with congenital scoliosis coexisting with hemivertebrae. This study evaluated the outcomes of a posterior-only surgical approach, dividing the cohort into 2 groups based on the surgical technique applied: 23 patients underwent total hemivertebrae resection (TR), whereas 20 patients received partial hemivertebrae resection (PR), accompanied by short-segment fusion.

RESULTS

There were 43 patients with congenital scoliosis associated with hemivertebrae in both the PR and TR groups. The average age at the time of surgery was 6.3 ± 2.0 years for the PR group and 6.0 ± 1.9 years for the TR group. The PR group exhibited a comparable correction rate of the Cobb angle at postoperation (4.3 ± 4.9 and 2.2 ± 3.2, P = .174) and the last follow-up (7.8 ± 1.3 and 5.5 ± 2.3, P = .113) compared with the TR group.

CONCLUSION

Partial hemivertebra resection is efficient and secure. A less invasive technique obtained an equivalent, well-maintained correction rate to the total hemivertebra resection. However, this is the initial result, and the patients continue to be followed; we will await the results of the outcome at full-growth sprouts.

Adjacent intervertebral disc preservation or not during hemivertebra resection in the treatment of congenital scoliosis: a minimum of 5-year follow-up

OBJECTIVE

To evaluate and compare whether removing the intervertebral disc (IVD) adjacent to the hemivertebra (HV) affects the therapeutic outcome of hemivertebra resection in pediatric patients.

METHODS

Pediatric patients who were diagnosed with single fully segmented or semi-segmented hemivertebra from 2011 to 2018 were included. Patients were grouped based on whether removal of IVD(s) adjacent to HV. Radiographic parameters were evaluated. Operative results were evaluated based on the correction rate after surgery and at the last follow-up. Demographic and surgical data together with perioperative complications were also analyzed.

RESULTS

Total 42 patients were included in our study, including 25 patients in the IVD preservation group (group P) and 17 patients in the IVD removal group (group R). Two groups showed similar results in terms of baseline demographics and operational data other than the estimated blood loss (EBL). The IVD preservation group presented with significantly more EBL. Both two groups showed significant postoperative scoliosis correction. However, no significant difference was found between the two groups in terms of coronal balance and radiographic parameters in the sagittal plane (segmental kyphosis, sagittal vertical axis) or overall complication rate.

CONCLUSIONS

Preservation of IVD during the procedure was associated with less blood loss. However, IVD preservation procedures did not show more scoliosis recurrence or deteriorating long-term scoliosis correction outcomes. Thus, removal of HV adjacent IVD for the sake of long-term scoliosis correction outcome at the expense of increasing blood loss is doubtful and deserves further study in pediatric congenital scoliosis caused by hemivertebra.

Posterior Hemivertebra Extended Resection Combined With Concave Anterior Column Reconstruction for Congenital Scoliosis

BACKGROUND

Posterior hemivertebra resection for hemivertebra deformities has been widely reported. However, achieving adequate correction of deformities through conventional hemivertebra resection remains technically challenging in older children. The authors developed a technique combining posterior hemivertebra extended resection with concave anterior column reconstruction. This study aimed to evaluate the outcomes of the modified posterior hemivertebra resection (MPHR) technique in older children with rigid congenital scoliosis.

METHODS

A retrospective analysis was conducted from June 2016 to February 2023 on 15 patients with congenital scoliosis, all of whom were over 10 years old and had less than 30% flexibility. They underwent posterior hemivertebra extended resection combined with concave anterior column reconstruction. The medical records and radiographs were reviewed to evaluate correction results and complications.

RESULTS

There were 7 males and 8 females with a mean age of 12.9±1.5 years. The mean follow-up time was 2.0±0.4 years. The segmental curve was 41±11 degrees preoperatively, 7±4 degrees postoperatively, and 8±4 degrees at the final follow-up, resulting in a correction rate of 80%. The segmental kyphosis improved from 41±26 to 7±7 degrees, resulting in a correction rate of 83%. The correction rate for the compensatory cranial and caudal curve were 59% and 66%, respectively. There was one superficial wound infection postoperatively.

CONCLUSIONS

The MPHR provides satisfactory correction of hemivertebra deformity in older children. The MPHR represents an alternative technique for older children with rigid curves.

LEVEL OF EVIDENCE

Level IV.

Surgical outcomes of Hemivertebra Resection with Mono-Segment Fusion in Children under 10 years with congenital scoliosis: a retrospective study stratified by the Crankshaft Phenomenon

BACKGROUND

Congenital early-onset scoliosis (CEOS), particularly due to hemivertebra, presents significant challenges in spinal deformity correction. The standard surgical approach, hemivertebra resection combined with short-segment fusion, can be complicated by the crankshaft phenomenon, a progressive deformity that may develop postoperatively. This study aims to evaluate the long-term surgical outcomes of single-stage posterior hemivertebra resection with mono-segment fusion in CEOS, stratified by the presence or absence of the crankshaft phenomenon.

METHODS

A retrospective analysis was performed on 31 CEOS patients who underwent single-stage posterior hemivertebra resection and mono-segment fusion between 2003 and 2019. Patients were grouped based on the presence (n = 9) or absence (n = 22) of the crankshaft phenomenon. Clinical and radiographic outcomes, including main curve correction, compensatory curves, apical vertebral translation (AVT), coronal balance (CB), and sagittal balance (SB), were assessed at preoperative, immediate postoperative, and latest follow-up points. Statistical analyses were performed using SPSS and R software.

RESULTS

The cohort showed significant deformity correction with an initial main curve angle reduction from 29.76° to 7.34° (76% correction rate), though some loss of correction was observed at the last follow-up (12.28°). The group with the crankshaft phenomenon exhibited a significantly lower initial correction rate (62%) compared to the non-crankshaft group (82%), with a higher rate of curve progression at follow-up (25.02° vs. 7.06°). Compensatory curves, AVT, and CB showed differences between groups, with those having the crankshaft phenomenon demonstrating worse outcomes. However, no significant differences were found in sagittal parameters (segmental kyphosis, thoracic kyphosis, and lumbar lordosis) between the two groups.

CONCLUSIONS

The study demonstrates that single-stage posterior hemivertebra resection with mono-segment fusion is effective in correcting deformities in CEOS patients. However, the presence of the crankshaft phenomenon is associated with a poorer long-term surgical outcome, including higher rates of curve progression and worse compensatory curve management. These findings highlight the importance of identifying the crankshaft phenomenon as a potential factor influencing the prognosis of surgical correction in CEOS.

Presence of compensatory curve predicts postoperative curve progression in congenital scoliosis after thoracolumbar hemivertebra resection and short fusion

PURPOSE

To investigate the impact of preoperative compensatory curve on the postoperative curve progression in congenital scoliosis (CS) patients following thoracolumbar hemivertebra (HV) resection and short fusion.

METHODS

This study retrospectively reviewed a consecutive cohort of patients with CS who underwent thoracolumbar HV resection and short fusion with a minimum of 2 years follow-up. According to the preoperative curve pattern, patients were divided into compensatory curve group non-compensatory curve group. Based on the postoperative coronal curve evolution, patients were further divided into the progressed group (Group P, with curve decompensation ≥ 20°) and the non-progressed group (Group NP, characterized by well-compensated curves).

RESULTS

A total of 127 patients were included in this study, with 31 patients in the compensatory curve group and 96 patients in the non-compensatory curve group. The incidence of postoperative coronal curve progression was significantly higher in the compensatory curve group than that in non-compensatory curve group (35.5% vs. 13.5%, p = 0.007). In the compensatory curve group, patients who experienced postoperative curve progression showed fewer fusion segments (p = 0.001), greater preoperative UIV translation (p = 0.006), greater preoperative LIV tilt (p = 0.017), and larger postoperative UIV tilt (p < 0.001) compared with patients in group NP. Multiple logistic regression demonstrated that the shorter fusion segments and greater postoperative UIV tilt were two independent risk factors for postoperative curve progression.

CONCLUSION

The presence of the compensatory curve was associated with a higher incidence of postoperative curve progression in patients with CS who underwent thoracolumbar HV resection and short fusion. Shorter fusion segments and greater postoperative UIV tilt were found to be the risk factors for postoperative curve progression.

Long-term results of single-stage posterior hemivertebra resection and short segment fusion using pedicle screws fixation in thoracolumbar congenital early-onset scoliosis: an 8.97-year average follow-up study

BACKGROUND

This study aims to evaluate the long-term outcomes of one-stage posterior hemivertebra resection and short segment fusion with pedicle screw fixation in children with thoracolumbar congenital early-onset scoliosis (TLCEOS). It specifically investigates the durability of spinal correction and the incidence of complications over an average follow-up of 8.97 years.

METHODS

A retrospective review was conducted on 32 patients treated at a tertiary scoliosis referral center from April 2003 to December 2019. Inclusion criteria were thoracolumbar hemivertebra (T11-L1), treatment via posterior hemivertebra resection and short segment fusion (≤ 5 segments), age under 10 years at surgery, and a follow-up of at least 5 years. Exclusions included idiopathic, syndromic, or neuromuscular scoliosis. Data on demographics, surgical procedures, and radiographic outcomes were collected, and clinical outcomes were evaluated using the Scoliosis Research Society-22 (SRS-22) questionnaire. Statistical analysis was performed using SPSS and R software.

RESULTS

The study included 32 patients (22 males, 10 females) with a mean age of 5.00 ± 2.42 years at surgery and an average follow-up of 8.97 ± 2.81 years. On average, 3.47 ± 1.11 segments were fused. The main curve corrected from 38.64° ± 14.12° preoperatively to 9.06° ± 7.29° postoperatively, with a final correction rate of 61%. Significant improvements were observed in the SRS-22 domains of Appearance and Satisfaction with Treatment. There were 17 complications, including neurological, pulmonary, and mechanical issues, with some cases requiring revision surgery.

CONCLUSIONS

One-stage posterior hemivertebra resection and short segment fusion with pedicle screw fixation effectively correct TLCEOS long-term, offering significant improvements in patient appearance and satisfaction, with a manageable complication profile.

Evaluation of the efficacy of posterior hemivertebrectomy combined with two or more segments fusion

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.

Analysis of the factors affecting the loss of correction effect in patients with congenital scoliosis after one stage posterior hemivertebrae resection and orthosis fusion

BACKGROUND

To analyze the factors affecting the loss of correction effect in patients with congenital scoliosis after one stage posterior hemivertebra resection, orthosis, fusion and internal fixation.

METHODS

Thirty-nine patients with congenital scoliosis (CS) who underwent one-stage posterior hemivertebra resection, orthosis, fusion and internal fixation were retrospectively included in Hebei Children's Hospital General demographic information of patients was collected. Preoperative and postoperative imaging indicators were compared, Including cobb Angle of the main curvature of the spine, segmental Cobb Angle, compensatory cephalic curve, compensatory curve on the caudal side, segmental kyphosis, coronal balance, sagittal balance, thoracic kyphosis, lumbar lordosis, and apical vertebra translation. Correlation analysis is used to evaluate the factors affecting the loss of judgment and correction effect, and the correlation indicators are included in the multi-factor Logistics regression.

RESULTS

In terms of radiographic indicators in the coronal plane, compared to preoperative values, significant improvements were observed in postoperative Cobb Angle of main curve (8.00°±4.62° vs. 33.30°±9.86°), Segmental Cobb angle (11.87°±6.55° vs. 31.29°±10.03°), Compensatory cephalic curve (6.22°±6.33° vs. 14.75°±12.50°), Compensatory curve on the caudal side (5.58°±3.43° vs. 12.61°±8.72°), coronal balance (10.95 mm ± 8.65 mm vs. 13.52 mm ± 11.03 mm), and apical vertebra translation (5.96 mm ± 5.07 mm vs. 16.55 mm ± 8.39 mm) (all P < 0.05). In the sagittal plane, significant improvements were observed in Segmental kyposis Angle (7.60°±9.36° vs. 21.89°±14.62°, P < 0.05) as compared to preoperative values. At the last follow-up, Segmental kyphosis Angle (6.09°±9.75° vs. 21.89°±14.62°, P < 0.05), Thoracic kyphosis (26.57°±7.68° vs. 24.06°±10.49°, P < 0.05) and Lumbar lordosis (32.12°±13.15° vs. 27.84°±16.68°, P < 0.05) had statistical significance compared with the preoperative department. The correlation analysis showed that the correction effect of the main curve Cobb angle was correlated with fixed segment length (rs=-0.318, P = 0.048), postoperative segment Cobb angle (rs=-0.600, P < 0.001), preoperative apical vertebra translation (rs = 0.440, P = 0.005), and spinal cord malformation (rs=-0.437, P = 0.005). The correction effect of segmental kyphosis was correlated with age (rs = 0.388, P = 0.037). The results of the multivariate logistic regression analysis revealed that postoperative segmental Cobb angle > 10° (OR = 0.011, 95%CI:0.001-0.234, P = 0.004), associated spinal cord anomalies (OR = 24.369, 95%CI:1.057-561.793, P = 0.046), and preoperative apical translation > 10 mm (OR = 0.012, 95%CI:0.000-0.438, P = 0.016) were influential factors in the progression of the main curve Cobb angle.

CONCLUSION

The one-stage posterior hemivertebra resection and short-segment corrective fusion with internal fixation are effective means to treat congenital scoliosis. However, attention should be paid to the loss of correction and curve progression during follow-up. Patients with spinal cord malformation and a large preoperative apical vertebra translation have a greater risk of losing the correction after surgery.

Circumferential Approach to Congenital Kyphoscoliosis with Hemivertebra: Adding on Rather than Resecting Could Be a Better Option in Older Adolescents

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.

Comparison of the Curative Efficacy of Hemivertebra Resection via the Posterior Approach Assisted With Unilateral and Bilateral Internal Fixation in the Treatment of Congenital Scoliosis

Objective

This study aimed to compare the curative efficacy of hemivertebra resection via the posterior approach assisted with unilateral and bilateral internal fixation in the treatment of congenital scoliosis (CS).

Methods

In this study, 29 children (15 males and 14 females), who underwent hemivertebra resection via the posterior approach and received internal fixation from November 2005 to September 2018, were analyzed retrospectively. The age of these patients ranged from 0.9 to 15 years, with an average of 3.8 years. The follow-up duration ranged from 2 to 12.3 years, with an average of 5.7 years. The patients in group A received unilateral internal fixation, and those in group B received bilateral internal fixation. The operation duration, bleeding volume, and complications during the operation, as well as the Cobb angles of scoliosis and kyphosis before and after the operation and at the last follow-up, were compared between the two groups.

Results

In group A, the operation duration was 207.4 ± 54.5 min, and the bleeding volume was 215.3 ± 75.4 ml; in group B, the operation duration was 249.5 ± 51.0 min, and the bleeding volume was 291.3 ± 115.6 ml (P < 0.05). The Cobb angles of segmental scoliosis, segmental kyphosis, cephalic compensatory curve, and caudal compensatory curve were significantly improved in the two groups after operation and at the last follow-up (P < 0.05). The post-operative correction rate of the scoliosis Cobb angle was 67.2% in group A and 79.5% in group B; and the difference was statistically significant (P < 0.05). At the last follow-up, the correction rate of the scoliosis Cobb angle was 72.7% in group A and 76.2% in group B (P > 0.05). After the operation and at the last follow-up, the correction rates of kyphosis were 83.1 and 79.6% in group A and 71.8 and 65.5% in group B (P > 0.05).

Conclusion

Hemivertebra resection via posterior approach with unilateral internal fixation can also achieve the effect of bilateral internal fixation in the treatment of CS. It is able to preserve a certain degree of contralateral spinal growth potential and is a feasible method.