Treatment Of Congenital Scoliosis By One-Stage Posterior Hemivertebra Resction And 3-Dimensional Correction

Objectve To evaluate the effect and feasibility of one-stagehemivertebra resection and 3-dimensional correction in treatingcongenital spinal deformities caused chiefly by hemivertebra througha single posterior procedure, validate the suspicious factors thatpossibly affect the curative effect and find out the reasonable fusionstrategy for the patients of the 5-15 age group. Methods 13 cases with congenital spinal deformities causedchiefly by hemivertebra between October 2000 and November 2005.There were 5 boys and 8 girls with an average age of 10.5 years (range5 to 15 years). The location of hemivertebra was at thoracic region in6 cases, thoracolumbar region 6 cases and lumbar region 1 case. Ofthese cases, there were 9 cases with a fully segmentel hemivertebra, 4cases with multiple hemivertebra. The internal fixations, which wereused for the correction of the deformities, included Scofix-I in 4 casesand Scofix-II in 9 cases. Results The follow-up range form 6 monthes to 49 montheswith an average of 25 months. The average fused vertebra was 5.1segments (range 2 to 10 segments). Coronary TC: Mean Cobb angle was 59.2°preoperatively(range25°to 88°), 20.7°postoperatively(range 1°to 41°), and 27.5°atlatest follow-up (range 2°to 59°). The mean immediate correctionwas 64.8% (range 17.2% to 98.2%), the mean final correction was54.2% (range 10.3% to 96.4%), and the mean loss of the correctionwas 18.1%.Coronary SC: Mean Cobb angle was 42.5°preoperatively(range13°to 63°), 12.6°postoperatively (range 1°to 31°), and 14.2°at latest follow-up (range 1 ° to 28 ° ). The mean immediatecorrection was 71.6% (range 39.5% to 39.5%), the mean finalcorrection was 66.9% (range 25.9% to 96.4%), and the mean loss ofthe correction was 6.0%.Coronary FC: Mean Cobb angle was 35.8°preoperatively (range7°to 74°), 12.5°postoperatively (range 0°to 48°), and 15.5°atlatest follow-up (range 2°to 49°). The mean immediate correctionwas 68.9% (range 34.1% to 93.8%), the mean final correction was60.4% (range 30.8% to 88.2%), and the mean loss of the correctionwas 10.5%.Compensatory cranial curve: Mean Cobb angle was 27.9°preoperatively (range 7°to 52°), 14.7°postoperatively (range 2°to 38°), and 15.8°at latest follow-up (range 5°to 49°). The meanimmediate correction was 43.4% (range 22.2% to 77.8%), the meanfinal correction was 39.8% (range 2.0% to 75.6%), and the meanaggravation was 3.6%.Compensatory cranial curve: Mean Cobb angle was 23.2°preoperatively (range 5°to 44°), 7.2°postoperatively (range 1°to19°), and 13.7°at latest follow-up (range 1°to 40°). The meanimmediate correction was 65.0% (range 20.0% to 91.7%), the meanfinal correction was 40.4% (range -122.0% to 91.7%), and the meanaggravation was 24.6%.Trunk shift: Mean trunk shift was 13.3mm preoperatively (range1.4mm to 31.5mm), 14.5mm postoperatively (range 1.4mm to30.2mm), and 10.8mm at latest follow-up (range 1.4mm to 38.0mm).The mean immediate correction was-115.0% (range -650.0% to100.0%), the mean final correction was -48.4% (range -347.1% to86.0%), and the mean spontaneous correction was 66.6%.Sagital SC: Mean Cobb angle was 44.1° preoperatively(range 9°to 80°), 6.0°postoperatively (range -24°to 36°), and 4.0°atlatest follow-up (range -11°to 24°). The mean immediate correctionwas 84.4%, the mean final correction was 88.4%,and the meanspontaneous correction was 3.8%.Thoracic kyphosis: Mean differential Cobb angle was 19.5°preoperatively (range 2°to 72°), 10.7°postoperatively(range 1°to27°), and 14.6°at latest follow-up (range 4°to 31°).Lumbar lordosis: Mean differential Cobb angle was 21.6°preoperatively (range 6°to 86°), 10.5°postoperatively (range 5°to 28°), and 12.3°at latest follow-up (range 2°to 36°).The mean maximal anteflexion angle was 50.0°(range 32°to84°);The mean maximal extension angle was 18.2°(range 11°to25°);The mean maximal left lean angle was 9.5°(range 4°to 14°);The mean maximal right lean angle was 12.2°(range 4°to 19°).Discomfort of waist: Grade I -9 cases;Grade II -1 case;Grade III-2 cases;Grade IV -2 cases.Conclusions One-Stage Posterior Hemivertebra Resction and3-Dimensional Correction is a safe and promising procedure thatoffers significant advantages for controlling congenital deformity:excellent correction in both the frontal and sagittal planes, highstability, no need for an anterior approach, and low neurologic risk.The site of the hemivertebra, whether combined with other spinaldeformities or not, and the fusion strategy affect the curative effectevidently. Long segment of fusion is more suitable for the patients of5-15 age group.