Efficiency and safety of hemi vertebra resection for congenital scoliosis children coexisting asymptomatic intraspinal anomalies

English Keywords:Congenital scoliosis  Tethered cord  Split cord malformation  Syringomyelia  Neurological complication

English Abstract:

  【Abstract】 Objectives: To evaluate the efficiency and safety of hemivertebra resection in the treatment of children with congenital scoliosis coexisting asymptomatic intraspinal anomalies. Methods: Congenital scoliosis patients coexisting asymptomatic intraspinal anomalies who underwent hemivertebra resection from January 2012 to April 2017 were retrospectively reviewed. A total of 36 patients (15 males and 21 females) with a mean age of 6.6±2.7(2-9) years were included. The intraspinal anomalies were revealed by MRI including tethered cord, split cord malformation and syringomyelia. No obvious neurological symptoms were found in preoperative physical examination. On standing whole spinal X-rays at pre-operation, 1 week post-operation and the final follow-up, the Cobb angle, the distance between C7 plumb line and center sacral vertical line(C7PL-CSVL), the local kyphosis, and the sagittal vertical axis(SVA) were measured. The complications during surgery and follow-up were recorded. Results: The average Cobb angle was 37.7°±16.4° at pre-operation and 10.4°±9.2° at 1 week post-operation(P<0.001). The average correction rate was (72.4±27.9)% (P<0.001). The average local kyphosis was 20.3°±5.4° at pre-operation and 1.6°±3.4° at post-operation(P<0.001). The pre-operational and 1 week post-operational values were 10.6±5.4mm and 7.9±5.3mm for C7PL-CSVL, -6.4±19.8mm and 1.2±14.1mm for SVA. No significant difference was found between pre-operational and 1 week post-operation(P>0.05). The mean follow-up period was 46.1±20.3(12-72) months. Cobb angle, local kyphosis, C7PL-CSVL and SVA at the final follow-up were 11.3°±13.7°, 3.1°±7.2°, 9.1±4.8mm and 8.7±22.4mm, respectively. No significant correction loss was found during follow-up(P>0.05). Cerebrospinal fluid leakage occurred in one patient during surgery, who recovered after conservative treatment. The compensatory curve progressed more than 5° occurred in one patient and proximal junctional kyphosis occurred in 3 patients, which were well controlled after bracing treatment. There was no implant failure or neurological complication. Conclusions: The clinical outcomes of hemi-vertebra resection for congenital scoliosis coexisting asymptomatic intraspinal anomalies are satisfying, with the risks of neurological complications not significantly increasing.