Enigmas of hemivertebra: Current concepts in management

Hemivertebra (HV) is the most common cause of early-onset scoliosis. It can lead to a spectrum of spinal deformities ranging from mild spinal asymmetry to severe progressive scoliosis/kyphosis. Early diagnosis of HV, multi-disciplinary evaluation, and timely intervention are essential. The treatment strategies are influenced by patient age, magnitude of deformity, type of HV, and rate of deformity progression. The range of surgical options includes traditional in-situ fusion, convex growth arrest, posterior-only hemivertebra resection with short-segment fixation, and advanced navigation-assisted techniques for deformity correction. In-situ fusion at an early age may help stabilize local deformity, but it is associated with risks such as the crankshaft phenomenon, loss of growth potential, and cosmetic imbalance. In selected young patients, the convex epiphysiodesis offers growth modulation, but it is not suitable for complex curves. Posterior-only resection of an HV is the current standard of practice, with generally favorable outcomes. The ultimate aim of the surgery is to get a substantial correction of deformity while preserving motion segments and growth. The outcome depends on careful patient selection, precise surgical technique, and long-term follow-up.