Posterior hemivertebral resection for upper thoracic congenital scoliosis: be aware of high risk of complications.

The treatment of congenital hemivertebrae in the upper thoracic region is challenging. The objective of this study was to investigate the outcomes of posterior hemivertebral resection for the upper thoracic region. Twenty-one patients diagnosed with upper thoracic congenital scoliosis were included. All of them received hemivertebral resection surgery via the posterior-only approach with at least 2 years of follow-up. The radiographic parameters and Scoliosis Research Society-22 score were analyzed. All the intraoperative and postoperative complications were recorded retrospectively. The segmental main curve was 35.9° before surgery and 7.0° at the last follow-up, with an average correction rate of 80.2%. The total main curve was 44.1° before surgery and 11.6° at the last follow-up, with an average correction rate of 73.9%. The caudal compensatory curve was corrected from 20.2° to 7.1°, with an average correction rate of 64.9%. The segmental kyphosis was corrected from 30.9° to 8.9°, with an average correction rate of 65.5%. The total Scoliosis Research Society-22 score significantly improved in all patients at the last follow-up, mainly resulting from the improvement of the self-image, mental health, and satisfaction domains. The following complications were found: one pedicle fracture, two malpositioned screws, one transient neurologic deficit, one implant failure, and four postoperative curve progressions. Although good radiographic deformity correction and clinical results were achieved after surgery, the incidence rate of complications was high at 42.9%; great care should be taken to prevent them, especially for postoperative curve progression (19.0%).