Posterior Approach Hemivertebra Resection And Short-segement Fixation In Congenital Kyphoscoliosis Deformity In Children Under 6 Years Of Age

Objective : Congenital kyphoscoliosis deformity caused by hemivertebra, growth potential is similar to normal vertebral body, non- surgical treatments(such as gypsum or brace and traction, etc.)are often ineffective. Therefore, early hemivertebra resection is of great significance to control the deformity progression. This study selects a set of the average age of children less than 6 years old underwent posterior hemivertebra resection with short segment fixation and fusion treatment, to control the progress of scoliosis early and to evaluate the safety and efficacy of surgery. Methods: Thirty-one consecutive cases of congenital kyphoscoliosis treated by posterior approach hemivertebra resection and short segement fixation were investigated retrospectively from February 2009 to December 2014. Including 15 males and 16 females, aged from 23 months, average 45 months. All of 30 cases underwent posterior hemivertebra resection with short segment fixation, one patient underwent one stage osseous divide cut, tethered resection, and then taken hemivertebra resection. Intraoperative electrophysiological monitoring was applied in order to protect the safety of spinal cord. Preoperative, postoperative and follow-up shot total spinal radiographs, measurement of coronal and sagittal Cobb angle. The time and blood loss of operations were recorded. Through literature review,so as to evaluate the effect and safety of operation. Result: All of the operations were successful finished. The operation time was 133-288min(average,157±38.7min) and blood loss was 50-600ml(average,324.5± 175ml).We measured and recorded the data of the average correction of post-operative coronal main curve Cobb angel,kyphosis main curve Cobb angel. Two weeks after the operation, the correction rates respectively were 67.3% 、 50.1%(P<0.05).Compared with the data recorded, two weeks after the operations, the last follow-up visit, there was no significant difference(P>0.05).And the follow-up visit contained 23 months in average. One patient had lower extremity numbness and discomfort aggravating, lower extremity muscle strength and decreased skin feeling 9 d after surgery. Posterior spinal exploration and hematoma was performed under general anesthesia. Intraoperative can see local hematoma formation and compress the spinal cord. Patients with lower limb sensation and muscle strength better than before surgery. Another patient due to bone reaction, poor healing of incision, incision mouth debridement and suture, wound healing was better. During follow-up, the patient with lower extremity muscle strength and sensory recovery to normal. All patients, during the follow-up period, were in good recovery, no major complications(such as neurological impairment, infection, instrumentation mobilization or failure, effects of correction lose). Conclusion: Posterior hemivertebra resection is an effective procedure, which can control deformity become serious for congenital kyphoscoliosis. Surgery should be done as soon as possible so as to avoid the use of long segment arthrodesis, low neurological impairment risk and excellent frontal and sagittal correction.