One-stage Hemivertebrae Resection Posterioroly And Transpedicular Instrumentation For Correction Of Congenital Scoliosis

【Objective】Retrospective study with clinical evaluation of posterior hemivertebrae resection with transpedicular instrumentation for correction of congenital scoliosis .【Method】From Apr 2006 to Aug 2010,38 consecutive cases of congenital scoliosis (21 male and 17 female) were managed surgically with one-stage hemivertebrae resection posterioroly and transpedicular instrumentation。Mean age at time of surgery was 9.9 years old (1～18 years). The location of hemivertebra:thoracic 11 cases, thoracolumbar junction 15 cases,and lumbar 13 cases( two cases with two hemivertebras in thoracic and lumbar). Full-length standing radiographs were taken before and after surgery and at the final follow-up . The medical records were reviewed and the complications were recorded.The apical translation (C7 plumb line to center sacral vertical line and sagittal vertical axis),and the Cobb angle in the coronal and sagittal plane were measured and analyzed. Somatosensory evoked-potential monitoring or a wake-up test is recommended .The postoperative duration of brace wear is 3～6 months.【Result】They were retrospectively studied with a mean follow-up period of 20.9 months(12～36 months). The average operative time was 315 min (210～460min) with a mean 810 ml of blood loss (110～1850ml). The average fusion segments was 4.6,ranging from 2 to 12 segments.The Cobb angle in the coronal plane was corrected from 40.4°to 13.5°( correction rate 66.6%).The kyphosis was corrected from 34.6°to 11.4°( correction rate 67.1%).The apical translation of C7PL-CSVL was improved from 2.6cm (0.8～4.6cm) to 1.5 cm(0.4～2.7cm).The SVA translation was improved from 2.4cm(0.7～4.3cm) to 1.2cm(0.6～2.2cm). There was no pseudarthrosis, infection and pedicle fracture,but one sagittal decompensation.【Conclusion】One-stage hemivertebrae resection posterioroly and transpedicular instrumentation is a safe and effective procedure for congenital scoliosis with hemivertebrae. This procedure removed directly hemivertebrae body and disk, meanwhile reduced the rate of pseudarthrosis, and can achieve reliable fusion and satisfactory effect.