Application of cutting bone bridge and releasing concave side and hemivertebra resection for mild to moderate spinal congenital kyphoscoliosis in children

English Keywords:Congenital scoliosis  Mixed type  Operation  Children

English Abstract:

  【Abstract】 Objectives: To investigate the effect of cutting bone bridge, releasing concave side， semicorpectomy for mild to moderate spinal congenital kyphoscoliosis in children. Methods: From January 2001 to January 2013, 32 patients with spine congenital scoliosis combined with vertebral dyssegmentation and mixed vertebral body dysformation were treated with one-stage posterior hemivertebra resection, resection of bone bridge at concave side, release, and deformity correction through the pedicle screw system. There were 10 males and 22 females with the age ranging from 4 to 12 years old. The Cobb angle of scoliosis was 35°-78°(mean 58.3°±12.5°); kyphosis Cobb angle was 13°-55°( mean 47.6°±15.6°). Trunk shift was 11-32mm(average 18.2±5.5mm). The deformity located from T7 to L3, 11 cases had apical vertebra in thoracic, 13 cases in thoracolumbar, 8 cases in lumbar. Diastematomyelia was noted in 3 cases(T10-L1 in 1 case, T12-L2 in 1 case, T12 in 1 case), the lumbar nerve root cyst was noted in one case, tethered cord syndrome was noted in one case. Results: The operation time was 160-270min(average, 230±125min). Blood loss was 310-850ml(average 590±113ml). 2 cases were noted pedicle fracture during pedicle screw placement, then the fixed segment was adjusted. After operation, 1 case suffered from unilateral lower extremity weakness and numbness, which resolved by administration of methylprednisolone and dehydrating medicine for 1 week, cerebrospinal fluid leakage occurred in 2 cases. Postoperative spinal scoliosis Cobb angle was 5°-28°(average 13.8°±7.1°), with the correction rate of(76.3±9.5)％; kyphosis angle was 0-20°(average 15.1°±3.9°), with the correction rate of (68.3±11.2)％; trunk shift distance was 0-11.6mm(average 3.1±2.3mm). Follow-up was from 12 to 60 months(average 18.4±12.6 months), at final follow-up, the scoliosis correction rate decreased by (3.9±1.6)%, and the rate of kyphosis correction decreased by (2.3±0.9)%. No instrument failure was noted. Conclusions: For mild to moderate congenital spinal kyphosis, one-stage posterior hemivertebra resection, resection of bone bridge at concave side, release, and instrumentation have satisfactory outcome.