Hemivertebra resection and osteotomies in congenital spine deformity

Retrospective study of posterior hemivertebra resection and osteotomies with transpedicular instrumentation in very young children.

Assessment of early intervention in congenital scoliosis with almost complete correction of the main deformity.

There is a trend to early correction of congenital deformities, however, there is a lack of long-term follow-up.

Forty-one children aged 1 to 6 years with congenital scoliosis were operated on by hemivertebra resection by a posterior only approach with transpedicular instrumentation. Mean age at time of surgery was 3 years 5 months. They were retrospectively studied with a mean follow-up of 6 years 2 months.

In group 1 (patients without bar formation), the average Cobb angle of the main curve was 36 degrees before surgery and 7 degrees after surgery. Compensatory cranial curve improved spontaneously from 15 degrees to 3 degrees, compensatory caudal curve from 17 degrees to 4 degrees. The angle of kyphosis was 22 degrees before surgery and 8 degrees after surgery. In group 2 (patients with bar formation) the main curve improved from 69 degrees to 23 degrees, cranial curve from 27 degrees to 11 degrees, caudal curve from 34 degrees to 14 degrees, and kyphosis from 24 degrees to 9 degrees.

Posterior hemivertebra resection, in case of bar formation with osteotomy of the bar, allows for excellent correction in both the frontal and sagittal planes, with a short segment of fusion. Early surgery in young children prevents the development of severe local deformities and secondary structural curves, thus allowing for normal growth in the unaffected parts of the spine.