Reasons for failed primary operation and selection of revision methods for congenital kyphoscoliosis caused by a single hemivertebra

English Keywords:Congenital kyphoscoliosis  Hemivertebra  Correction  Failure  Revision

English Abstract:

  【Abstract】 Objective：To investigate the reasons for failed primary operation and selection of revision methods for congenital kyphoscoliosis due to a single hemivertebra.Method：From May 2000 to March 2008，11 patients with congenital kyphoscoliosis caused by a single hemivertebra undergoing revision surgery were enrolled.There were 5 males and 6 females，with the mean age of 11.5 years（ranged，2 to 19 years）.The preoperative scoliosis Cobb angle was 15°-97°（mean，52.2°），with the kyphotic Cobb angle of 25°-105°（mean，63.5°）.The horizontal distance between C7 plumb line（C7PL） and the central sacral vertical line（CSVL） was 1.2-5.6cm（mean，2.7cm） preoperatively.Result：Reasons for failed primary operation were as follows：inappropriate surgical procedure in 3 patients，poor instrumentation and meanwhile without hemivertebra resection and bone graft in 4，fixation without hemivertebra resection and bone graft in 2，improper intraoperative manipulation in 1，and poor instrumentation associated with incomplete hemivertebra excision in 1.The revision methods were individualized according to the primary surgical procedures and the reasons for revision.No major vascular injury， infection or death was noted.1 case had transient deterioration of previous neurological deficit.The mean postoperative Cobb angle of scoliosis was 22.3°（2°-66°），with a mean correction rate of 64%.The kyphotic Cobb angle averaged 26.1°（2°-61°），with an average correction rate of 59.6%.The postoperative horizontal distance between C7PL and CSVL averaged 1.4cm（0.7-2.5cm）.The final follow-up time varied between 1 year and 5 years after surgery（mean，2.3 years）.At final follow-up，the mean Cobb angle of scoliosis was 23.8°（4°-63°）；the kyphotic Cobb angle averaged 29.9°（0°-59°）；the horizontal distance between C7PL and CSVL averaged 1.2cm（0.3-3.1cm）.The one-year postoperative X-rays showed solid bony fusion without hardware failure in all the patients.Conclusion：Inappropriate selection of primary surgery remains the main reason for failed primary operation in congenital kyphoscoliosis caused by a single hemivertebra，and revision surgery should be individualized.