Technical aspects of performing a hemivertebrectomy for adolescent congenital scoliosis: Illustrative case

Hemivertebrae (HVs) are congenital spinal anomalies that disrupt normal vertebral formation, often leading to progressive spinal deformity. Segmented HV-associated scoliosis presents significant surgical challenges, requiring meticulous planning and precise execution for optimal outcomes.

A 12-year-old female presented with severe lumbar scoliosis (75° focal curve) due to a fully segmented supernumerary HV at L3-4, causing coronal trunk shift, pelvic obliquity, and activity-limiting back pain. A short-segment L1-5 posterior instrumented fusion with vertebral column resection was performed using stereotactic navigation for pedicle screw placement and a modular screw system to optimize surgical access. The HV was resected using ultrasonic bone-cutting instruments, osteotomes, and a coarse diamond drill. Deformity correction was achieved through controlled compression and distraction forces with cobalt-chromium rods. Postoperatively, the patient experienced transient radicular pain, which resolved within 4 weeks with conservative management.

This case highlights the challenges of delayed HV detection and the importance of advanced surgical techniques for deformity correction. Stereotactic navigation, modular instrumentation, and careful execution of a hemivertebrectomy facilitated optimal correction while preserving mobility in adjacent spinal regions. A tailored approach is critical for long-term stability and functional outcomes. https://thejns.org/doi/10.3171/CASE25244.