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Hemivertebral excision for congenital scoliosis in very young children
W R Klemme1, D W Polly, J R Orchowski
1Department of Orthopaedic Surgery and Rehabilitation, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA. William.Klemme@na.amedd
Insights
Single-anesthetic sequential anterior and posterior hemivertebral excision effectively corrects congenital scoliosis in young children. This safe procedure offers excellent, lasting curve correction with no major complications.
Area of Science:
- Pediatric Orthopedics
- Spinal Surgery
- Congenital Deformities
Background:
- Congenital scoliosis in very young children often requires surgical intervention.
- Unbalanced hemivertebrae can lead to high-magnitude or progressive spinal deformities.
- Traditional surgical approaches may pose risks in this age group.
Purpose of the Study:
- To evaluate the safety and efficacy of single-anesthetic sequential anterior and posterior hemivertebral excision.
- To assess curve correction and long-term outcomes in very young children with congenital scoliosis.
- To determine the feasibility of this combined surgical approach in pediatric patients.
Main Methods:
- Retrospective analysis of six children under 34 months old with congenital scoliosis.
- All patients underwent single-anesthetic sequential anterior and posterior hemivertebral excision.
- Postoperative assessment included spinal radiographs for curve correction and follow-up for at least 24 months.
Main Results:
- Excellent initial and maintained curve correction (mean 67% postoperatively, 70% at follow-up).
- Solid arthrodesis confirmed on radiographs with no evidence of curve progression.
- No neurologic or other significant complications were reported in any patient.
Conclusions:
- Single-anesthetic sequential anterior and posterior hemivertebral excision is a safe and effective treatment for congenital scoliosis in very young children.
- The procedure provides significant and durable correction of spinal deformity.
- This approach offers a viable surgical option for managing complex pediatric spinal conditions.
Abstract:
The present study reports the results of a consecutive series of six very young children who underwent single-anesthetic sequential anterior and posterior hemivertebral excision. The children, all less than 34 months old (mean age 19 months), presented with high magnitude or progressive congenital scoliosis related to an unbalanced hemivertebra. Curve correction required hemivertebral excision, which was accomplished during a single operative event using sequential anterior and posterior procedures. The intraoperative curve correction was maintained with plaster immobilization for 3 months. All patients were followed for at least 24 months. Pre-and postoperative spinal radiographs were analyzed for initial and final curve correction. Excellent correction of preoperative deformity was obtained and maintained throughout the follow-up period. The mean postoperative curve correction (67%; range 52%-84%) compared favorably with the average correction at final follow-up (70%; range 50%-85%). Radiographs revealed a consistently solid arthrodesis with no evidence of curve progression. There were no neurologic or other significant complications. In conclusion, single-anesthetic sequential anterior and posterior hemivertebral excision appears to be a safe and efficacious procedure for the management of congenital scoliosis in very young children.
