Treatment Of Congenital Kyphoscoliosis With Selective-partial Hemivertebra Resection And Instrumentation Via Posterior Approach Only

BACKGROUND Hemivertebra is the most common type of congenital kyphoscoliosis. Kyphoscoliosis caused by a hemivertebra is mostly progressive and usually require surgery, as it is difficult to correct and prevent by conservative treatment. The commonly used operation methods for kyphoscoliosis caused by a hemivertebra have their own flaws and shortcomings. At present, most scholars advocate complete resection with internal fixation for full segmented hemivertebra with large growth potential. Complete hemivertebra resection can gain great orthopedic effect indeed, but it is also accompanied by severer trauma and more complications. Whether all of this kind of patient needs complete hemivertebra resection? Up to now, there is none of research report of selective-partial hemivertebra resection and instrumentation via posterior approach only for congenital kyphoscoliosis.OBJECTIVE To assess the correction effect of selective-partial hemivertebra resection and instrumentation via posterior approach only for patients of congenital kyphoscoliosis between9-14years old, with Risser sign between0-3grade, and with Cobb angle less than60degrees.METHODS This study includes17cases treated by selective-partial hemivertebra resection and instrumentation via posterior approach only. The mean age is10.8years. The mean Risser sign is1.82. The average time of follow-up is20.12months. The classification of hemivertebra is fall segmented hemivertebra. The Cobb angles of the main curves, segmental curves and segmental kyphotic curves are measured before and after operation, and at the latest follow-up. The data is analyzed to evaluate the correction effect.RESULTS There is none of infections and none of neurological deficits. The correction rate of the segmental curve is64.9%, as the mean Cobb angle is38.7degrees before operation,13.6degrees after operation, and16.6degrees at the latest follow-up. The correction rate of the main curve is65.7%, as the mean Cobb angle is42.9degrees before operation,14.7degrees after operation, and17.5degrees at the latest follow-up. The correction rate of the segmental kyphotic curve is72.6%, as the mean segmental kyphotic angle is22.6degrees before operation,6.2degrees after operation, and6.9degrees at the latest follow-up.CONCLUSIONS For the patients who are between9-14years old, with the Risser sign between0-3grade, and with the Cobb angles less than60degrees, the selective-partial hemivertebra resection and instrumentation via posterior approach only can balance the growth on the two sides of the spine, and achieve satisfactory therapeutic effect through individualized treatment of extra growth center resection.