One-stage Posterior Hemivertebra Resection With Transpedicular Instrumentation In Congenital Scoliosis

Objective:To evaluate the effect feasibility of one-stage posterior hemivertebra resection and transpedicular instrumentation in treating congenital spinal deformities caused chiefly by hemivertebra through a single posterior procedure.Methods:28 patients with congenital spinal deformities caused chiefly by hemivertebra were treated by one-stage hemivertebra resection and transpedicular instrumentation through a single posterior procedure between May 2004 and December 2008.There were 13 males and 15 females with an average of 11.4 years (range 4 to 16 years).Of these patients,there were 17 patients with a fully segmented hemivertebrae,9 patients with two and 2 patients with multi-hemivertebra.3 patients were associated with contralateralbar or rib fusion,4 with diastematomyelia,2 with tethered cord,2 with neurofibromatiosis,1 with intraspinal teratoma,1 with syringomyelia and 1 with congenital heart disease respectively.The location of hemivertebra was at thoracic region in 15 patients,thoracolumba region in 6 patients and lumbar region in 7 patients.The coronal Cobb's angle was 44.38±21.02°(range 10°～110°),while the sagittal Cobb's angle was 64.80±22.24°(range 27°～95°)preoperatively in which 2 patients of single kyphosis Cobb's angle was 43°and 80°,and 13 patients were associated with kyphosis.Results:The operation time was 175～405minutes(average 279.6 minutes). The blood loss was 400～2000ml(average 1046 ml).The average fusion levels were 6.9(3～12).The postoperative coronal and sagittal Cobb's angle was 11.00±9.08°(0°～31°) and 28.33±12.54°(10°～70°),respectively.The coronal corrective rate was 75%while sagittal corrective rate was 56.3%.3 patients occurred pleura rupture,no one experienced hemopneumothorax by direct anastomosis or plugging with soft tissue,2 patients had paraplegina but one recovered 3 months later by conservative treatment,and the other restorated gradually after hematoma evacuation due to spinal hematoma.The follow-up ranged from 1month to 4 years and 5 months with an average of 2 years and 1 month.According to the latest results, the coronal and sagittal Cobb's angle was 11.62±9.55°(0°～42°)and 29.13±15.41°(10°～67°),respectively.The coronal corrective rate was 73.9%while sagittal corrective rate was 55%.There were no pseudarthroses,dislocation of the screw or rod except pedical cutting by pedical screw and vertebrae body cutting by meshcage in each one.There was no trunk imbalance at final follow-up evaluation in all patients.Conclusion:The effect of one-stage posterior hemivertebra resection and transpedicular instrumentation was satisfactory and reliable in the treatment of congenital scoliosis and kyphosis caused chiefly by hemivertebra.The operation was safe,and no associated adverse complications were noted in the follow-up.