P M Keller1, R E Lindseth, G P DeRosa. 1. Indiana University School of Medicine, Department of Orthopaedic Surgery, Indianapolis.
Abstract
STUDY DESIGN: Patients treated with a transpedicular anterior and posterior convex hemiepiphysiodesis and hemiarthrodesis for progressive congenital scoliosis were followed to evaluate this treatment. OBJECTIVE: To evaluate an alternative to a separate anterior approach for performing an anterior hemiepiphysiodesis for progressive congenital scoliosis. SUMMARY OF BACKGROUND DATA: Previous investigators have reported a transpedicular anterior fusion combined with a bilateral posterior fusion. The authors are unaware of a previous report on a transpedicular anterior convex hemiepiphysiodesis and fusion combined with a unilateral convex posterior spinal fusion to treat progressive congenital scoliosis. METHODS: Nineteen curves were fused in 16 patients who had a variety of congenital anomalies. The average age at surgery was 4.8 years (range, 11 months to 13 years) The average follow-up period was 4.8 years (range, 2 to 9.6 years). RESULTS: The average preoperative and postoperative fused curves measured 36 degrees and 38 degrees, respectively. Of the 19 fused curves, seven curves (37%) improved, eight curves (42%) were unchanged or progressed less than 7 degrees, three curves (16%) progressed 10 degrees to 15 degrees, and one curve (5%) progressed more than 15 degrees. CONCLUSIONS: This procedure appears to be most effective in arresting growth in the young patient who has an isolated hemivertebrae and no excessive kyphosis. The epiphysiodesis effect is less predictable.
STUDY DESIGN:Patients treated with a transpedicular anterior and posterior convex hemiepiphysiodesis and hemiarthrodesis for progressive congenital scoliosis were followed to evaluate this treatment. OBJECTIVE: To evaluate an alternative to a separate anterior approach for performing an anterior hemiepiphysiodesis for progressive congenital scoliosis. SUMMARY OF BACKGROUND DATA: Previous investigators have reported a transpedicular anterior fusion combined with a bilateral posterior fusion. The authors are unaware of a previous report on a transpedicular anterior convex hemiepiphysiodesis and fusion combined with a unilateral convex posterior spinal fusion to treat progressive congenital scoliosis. METHODS: Nineteen curves were fused in 16 patients who had a variety of congenital anomalies. The average age at surgery was 4.8 years (range, 11 months to 13 years) The average follow-up period was 4.8 years (range, 2 to 9.6 years). RESULTS: The average preoperative and postoperative fused curves measured 36 degrees and 38 degrees, respectively. Of the 19 fused curves, seven curves (37%) improved, eight curves (42%) were unchanged or progressed less than 7 degrees, three curves (16%) progressed 10 degrees to 15 degrees, and one curve (5%) progressed more than 15 degrees. CONCLUSIONS: This procedure appears to be most effective in arresting growth in the young patient who has an isolated hemivertebrae and no excessive kyphosis. The epiphysiodesis effect is less predictable.