Y Shono1, K Abumi, K Kaneda. 1. Department of Orthopaedic Surgery, Hokkaido University School of Medicine, Sapporo, Japan. shono@med.hokudai.ac.jp
Abstract
STUDY DESIGN: A retrospective study of 12 patients with congenital kyphoscoliosis caused by a single hemivertebra who underwent one-stage posterior hemivertebra resection and correction by posterior segmental instrumentation. OBJECTIVES: To evaluate the surgical outcomes of 12 patients with hemivertebra treated by hemivertebra resection by single posterior approach and correction with segmental posterior instrumentation. SUMMARY OF BACKGROUND DATA: Congenital scoliosis caused by hemivertebra causes extremely severe curves in some patients. Posterior fusion or posterior and anterior hemi-epiphysiodesis is performed to prevent progression of the deformity. The results of these procedures have been variable and not promising, especially in an adolescent patient with fixed kyphoscoliotic deformity. Hemivertebra resection offers more certain results and better correction of the deformity. To date, hemivertebra resection is performed by anterior and posterior approaches either by one-stage or two-stage operation. Few reports have been published describing a procedure consisting of one-stage posterior hemivertebra resection and correction of the deformity by segmental posterior instrumentation. METHODS: A total of 12 patients with a single hemivertebra between the ages 8-24 years who underwent operative treatment were evaluated for a minimum of 2 years. All patients had a single nonincarcerated hemivertebra [T9 (1 patient), T10 (2), T11 (2), T12 (4), and L1 (3)]. After posterior hemivertebra resection, segmental posterior instrumentation was used for correction of the kyphoscoliotic deformity [CD (4 patients), Kaneda SR (2), and ISOLA (6)]. Radiographic evaluations were conducted on the preoperative, postoperative, and follow-up standing posteroanterior and lateral radiographs. RESULTS: All 12 patients had kyphoscoliotic deformity. Preoperative scoliosis averaging 49 degrees was corrected to 18 degrees (correction rate, 64%). Preoperative kyphosis of 40 degrees was corrected to 17 degrees of kyphosis. Trunk shift of 23 mm was improved to 3 mm. Correction loss was 2 degrees in the frontal plane and 3 degrees in the sagittal plane, and no patients showed more than 5 degrees of correction loss. No intraoperative complications were noted. Solid fusion was obtained in all patients, and no implant failure was verified at the final radiographic evaluations. CONCLUSIONS: This study indicated that correction of kyphoscoliosis caused by a single hemivertebra can be effectively conducted by one-stage posterior hemivertebra resection and correction using segmental posterior instrumentation. The operation was safe, and no associated adverse complications were noted. This procedure is best indicated for adolescent patients with a structural kyphoscoliotic deformity caused by a thoracic or thoracolumbar single hemivertebra.
STUDY DESIGN: A retrospective study of 12 patients with congenital kyphoscoliosis caused by a single hemivertebra who underwent one-stage posterior hemivertebra resection and correction by posterior segmental instrumentation. OBJECTIVES: To evaluate the surgical outcomes of 12 patients with hemivertebra treated by hemivertebra resection by single posterior approach and correction with segmental posterior instrumentation. SUMMARY OF BACKGROUND DATA: Congenital scoliosis caused by hemivertebra causes extremely severe curves in some patients. Posterior fusion or posterior and anterior hemi-epiphysiodesis is performed to prevent progression of the deformity. The results of these procedures have been variable and not promising, especially in an adolescent patient with fixed kyphoscoliotic deformity. Hemivertebra resection offers more certain results and better correction of the deformity. To date, hemivertebra resection is performed by anterior and posterior approaches either by one-stage or two-stage operation. Few reports have been published describing a procedure consisting of one-stage posterior hemivertebra resection and correction of the deformity by segmental posterior instrumentation. METHODS: A total of 12 patients with a single hemivertebra between the ages 8-24 years who underwent operative treatment were evaluated for a minimum of 2 years. All patients had a single nonincarcerated hemivertebra [T9 (1 patient), T10 (2), T11 (2), T12 (4), and L1 (3)]. After posterior hemivertebra resection, segmental posterior instrumentation was used for correction of the kyphoscoliotic deformity [CD (4 patients), Kaneda SR (2), and ISOLA (6)]. Radiographic evaluations were conducted on the preoperative, postoperative, and follow-up standing posteroanterior and lateral radiographs. RESULTS: All 12 patients had kyphoscoliotic deformity. Preoperative scoliosis averaging 49 degrees was corrected to 18 degrees (correction rate, 64%). Preoperative kyphosis of 40 degrees was corrected to 17 degrees of kyphosis. Trunk shift of 23 mm was improved to 3 mm. Correction loss was 2 degrees in the frontal plane and 3 degrees in the sagittal plane, and no patients showed more than 5 degrees of correction loss. No intraoperative complications were noted. Solid fusion was obtained in all patients, and no implant failure was verified at the final radiographic evaluations. CONCLUSIONS: This study indicated that correction of kyphoscoliosis caused by a single hemivertebra can be effectively conducted by one-stage posterior hemivertebra resection and correction using segmental posterior instrumentation. The operation was safe, and no associated adverse complications were noted. This procedure is best indicated for adolescent patients with a structural kyphoscoliotic deformity caused by a thoracic or thoracolumbar single hemivertebra.
Authors: I Teoman Benli; Erbil Aydin; Ahmet Alanay; Onat Uzümcügil; Osman Büyükgüllü; Mahmut Kis Journal: Eur Spine J Date: 2006-01-05 Impact factor: 3.134