Efficacy and complication of posterior hemivertebra resection in infants with congenital scoliosis

English Keywords:Infants  Congenital scoliosis  Hemivertebra resection  Posterior surgery  Complications

English Abstract:

  【Abstract】 Objectives: To evaluate the complication and efficacy of posterior hemivertebra resection with transpedicular instrumentation in infants with congenital scoliosis. Methods: From January 2003 to January 2012, 39 consecutive cases of congenital scoliosis due to hemivertebra were retrospectively investigated in our hospital, including 18 females and 21 males, aged from 2 to 5 years(average 3.4 years). Three cases were combined with congenital cardiac malformation, one case had previous spinal cord untethering procedure, and one case was combined with syringomyelia. All the patients underwent posterior hemivertebra resection with pedicle screw fixation. The medical records were reviewed and long cassette spinal radiographs of spine were measured at preoperation, postoperation and final follow-up to record the corrections and complications. Results: The mean operation time was 189.9±56.8min with an average blood loss of 306.6±152.3ml. The total number of resected hemivertebrae was 43, including 35 cases with one hemivertebra and 4 cases with two. The average fused segments were 3.4±1.4, including monosegmental fusion of two adjacent vertebrae in 22 cases(56.4%). The average follow-up was 5.9±2.6 years. The segmental coronal Cobb′s angle was corrected from 39.3°±12.2° before surgery to 6.3°±7.2° after surgery with a mean correction rate of (85.2±14.8)%, and the segmental kyphosis was corrected from 17.7°±17.0° to 2.9°±8.2° with a mean correction rate of (87.0±69.0)% over the same time period. The spontaneous correction rate of the compensatory cranial curve and compensatory caudal curve was (72.0±46.4)% and (81.8±34.5)% respectively, the Cobb′s angles of the curves before surgery and after surgery was significant differences(P＜0.05). Complications were found in 3 patients(7.6%), including 1 pedicle fracture, 1 rod breakage, 1 curve progression. There was no neurological complication. Two cases needed implant removal because of pedicle elongation in the follow-up. Conclusions: Posterior hemivertebra resection is a safe and effective procedure in infants with congenital scoliosis. Short-segment fusion and saving more mobile segments are possible in the procedure. However, complications associated with implants and spinal growth still remain a challenge.