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Modified Posterior Vertebral Column Resection for Patients with Thoracolumbar Kyphotic Deformity
Published on: September 16, 2022
Hemivertebra resection in the cervical spine
Michael Ruf1, Rubens Jensen, Jürgen Harms
1Department of Orthopedics and Traumatology, Center for Spinal Surgery, Klinikum Karlsbad-Langensteinbach, Germany. michael.ruf@kkl.srh.de
Insights
Surgical resection of cervical hemivertebra effectively treats congenital cervical scoliosis and associated head tilt in children. Early intervention with hemivertebra resection can prevent further spinal deformities.
Area of Science:
- Pediatric Orthopedics
- Spine Surgery
- Congenital Deformities
Background:
- Congenital cervical scoliosis, often associated with hemivertebra, presents a unique surgical challenge.
- This study reports on hemivertebra resection in the midcervical spine, a novel approach.
Observation:
- Three pediatric patients with congenital cervical scoliosis and torticollis underwent hemivertebra resection.
- The surgical approach involved posterior-anterior (posterior) resection and fusion of adjacent vertebrae.
Findings:
- Significant correction of segmental Cobb angle (29° to 5°) and head tilt (17° to 1°) was achieved.
- Complete bony fusion was successful in all patients, with one case of transient deltoid weakness resolving post-revision.
Implications:
- Cervical hemivertebra resection is a viable treatment option for congenital cervical scoliosis.
- Early surgical correction can prevent secondary deformities in the upper thoracic spine.
- This technique offers good correction of both spinal deformity and head tilt.
Study Design:
Retrospective study with clinical and radiologic evaluation of hemivertebra resection in children with congenital cervical scoliosis.
Objective:
Assessment of hemivertebra resection in the treatment of congenital cervical scoliosis.
Summary Of Background Data:
To our knowledge, this is the first report on hemivertebra resection in the midcervical spine.
Methods:
Three patients with torticollis due to a cervical hemivertebra were operated on by hemivertebra resection and fusion of the adjacent vertebrae. Resection was performed by a posterior-anterior (-posterior) approach. Mean age at time of surgery was 9 years 3 months. They were retrospectively studied with a mean follow-up of 4.8 years.
Results:
Mean segmental Cobb angle at the hemivertebra was 29 degrees before surgery, 5 degrees after surgery, and 6 degrees at latest follow-up. Head tilt improved from 17 degrees before surgery to 1 degrees after surgery, and 3 degrees at latest follow-up. Bony fusion was achieved in all cases. There was weakness of the left deltoid muscle in 1 case due to C5 root compression by a facet screw, which resolved completely after revision with change of the screw.
Conclusions:
Resection of a cervical hemivertebra may be an option in the treatment of congenital cervical scoliosis. A good correction of the local deformity and a complete correction of head tilt are achieved. By early operation in young children, the development of severe secondary deformities in the upper thoracic spine can be avoided.
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