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[Hemivertebra resection in congenital scoliosis -- early correction in young children]
M Ruf1, R Jensen, D Jeszenszky
1Orthopädie und Traumatologie, Wirbelsäulenchirurgie, Klinikum Karlsbad-Langensteinbach, Karlsbad, Germany. michael.ruf@kkl.srh.de
Insights
Early surgical resection of hemivertebrae effectively corrects congenital scoliosis in young children. This posterior approach with transpedicular instrumentation improves spinal alignment and allows for continued growth.
Area of Science:
- Orthopedic surgery
- Pediatric spinal deformities
- Congenital scoliosis
Context:
- Congenital scoliosis caused by hemivertebrae often leads to severe deformities during growth.
- Early intervention is crucial for optimal outcomes in young children.
Purpose:
- To evaluate the efficacy of posterior hemivertebra resection with transpedicular instrumentation for congenital scoliosis in young children.
Summary:
- Thirty-three children (aged 1-6 years) underwent surgical resection of 36 hemivertebrae.
- Mean follow-up was 4.5 years.
- The procedure significantly corrected the main curve (Cobb angle from 45.9° to 9.9°) and compensatory curves, as well as kyphosis.
Impact:
- Posterior hemivertebra resection with transpedicular instrumentation enables early surgical correction of congenital scoliosis in very young patients.
- This technique achieves excellent correction in both frontal and sagittal planes.
- Short-segment fusion preserves growth in unaffected spinal segments.
Background:
Congenital scoliosis due to hemivertebrae usually progresses during further growth and leads to severe deformities. Early correction in young children is therefore required.
Patients:
Thirty-six hemivertebrae in 33 children aged 1 to 6 years (average 3 years 5 months) underwent surgical intervention. Mean follow-up was 4.5 years (2 months to 13 years).
Methods:
The hemivertebra was resected by a posterior approach. The gap after resection was closed by compression via a transpedicular instrumentation, thus correcting the scoliotic deformity.
Results:
Mean Cobb angle of the main curve was 45.9 degrees preoperatively, 11.9 degrees postoperatively, and 9.9 degrees at latest follow-up. The compensatory cranial curve improved spontaneously from 18.4 degrees preoperatively to 5.0 degrees postoperatively and 3.7 degrees at latest follow-up. The compensatory caudal curve improved from 21.3 degrees to 6.7 and 5.4 degrees. The angle of kyphosis was 22.8 degrees preoperatively, 8.9 degrees postoperatively, and 6.8 degrees at latest follow-up. There was one infection, 2 pedicle fractures, and 3 implant failures. In 3 patients additional operations were performed due to new developing deformities.
Conclusion:
Correction surgery of congenital scoliosis should be performed early before the development of severe local deformities and secondary structural changes. Posterior resection of the hemivertebrae with transpedicular instrumentation allows for early intervention in very young children. Excellent correction in both the frontal and sagittal planes, and a short segment of fusion allow for normal growth in the unaffected parts of the spine.
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