Outcome analysis of posterior hemivertebra resection and correctional surgery for the treatment of cervicothoracic hemivertebra deformity

English Keywords:Hemivertebra deformity  Hemivertebra resection  Cervicothoracic hemivertebra  Correction outcomes

English Abstract:

  【Abstract】 Objectives: To evaluate the radiographic outcomes of one-stage posterior hemivertebra resection in the treatment of cervicothoracic hemivertebra deformity. Methods: From June 2010 to April 2017, 32 cases with cervicothoracic hemivertebra deformity who were managed by one-stage posterior hemivertebra resection and met the inclusion criteria were reviewed. There were 15 boys and 17 girls with a mean age of 10.1±4.2 years(range, 5-18 years). There were 25 cases with one hemivertebra and 7 cases with two hemivertebrae. The hemivertebra located in C7 in 1 patient, T1 in 5 patients, T2 in 12 patients, T3 in 10 patients and T4 in 11 patients. Before surgery, all patients had torticollis and shoulder imbalance. The following radiographic parameters were measured: local scoliosis, local kyphosis, shoulder balance, neck tilt, head shift, and sagittal parameters. The paired Student′s t test was used to analyze the data. Results: The operation time was 175-275 minutes(223.8±41.6min), the blood loss was 310-470ml(342.3±45.9ml). There were one case with Horner syndrome, two cases with transient radicular pain of arm after surgery, and one case with pleural tear during surgery, all these patients recovered after conservation treatment. A total of 261 pedicle screws was placed. The incidence of pedicle screw malposition was 7.3% without any neurovascular injury. The mean follow-up period was 19.3±10.5 months. Local scoliosis was significantly corrected from 41.1°±12.3° preoperatively to 17.5°±6.7° postoperatively(P＜0.001) and 20.1°±5.8° at last follow-up with no significant correction loss(P=0.102). Local kyphosis was significantly corrected from 21.5°±9.1° preoperatively to 16.8°±6.3° postoperatively(P＜0.05) and 17.5°±4.9° at last follow-up with no significant correction loss(P=0.102). The distal compensatory curve was corrected from 16.9°±5.3° preoperatively to 12.2°±5.5° postoperatively(P＜0.001), which slightly increased to 15.5°±7.7° at last follow-up(P=0.053). T1 tilt, clavicle angle, neck tilt and head shift were significantly improved at postoperation and no significant correction loss was found during follow-up. Conclusions: For patients with cervicothoracic hemivertebra deformity, one-stage posterior hemivertebra resection with instrumentation has shorter operation time, less operation wound and optimistic deformity correction.