Hemivertebrae

Abstract: Study design Evaluation of the long-term results for single fully segmented hemivertebrae were subjected to single-stage excision via posterior approach alone. Objectives To describe the long-term results of this procedure. Summary of background data In the case of congenital spinal deformity caused by a single, full hemivertebra, excision of the hemivertebra is ideal for obtaining a good correction percentage even in short segments. Recently, single-stage excision of a hemivertebra using a combined anterior and posterior approach has been reported. Methods Five patients with a hemivertebra underwent surgery. The hemivertebra involved the thoracolumbar region in three cases and the lumbosacral region in two cases. After removal of a lamina of the hemivertebra, the body of the hemivertebra was visualized easily because the spinal cord had deviated to the concave side of the curve. The vertebral body, along with its cranial and caudal discs, was curetted with this approach. Thereafter, bone chips were grafted into the defect created by vertebrectomy. The results of this surgical procedure, especially those observed during long-term follow-up evaluation, were investigated. Results For patients with a thoracolumbar hemivertebra, scoliosis improved from 49 degrees +/- 6 degrees to 22.3 degrees +/- 3.5 degrees, for a 54.3% correction. The correction ratio for kyphosis was 67.4%. Over an average 12.8-year follow up period, loss of scoliotic curvature correction was only 3.7 degrees. In contrast, the hemivertebral correction ratio for patients with a lumbosacral hemivertebra remained 32.5% because of difficulty using internal fixation associated with patient age. At the most recent follow-up assessment, one patient exhibited deterioration of coronal spinal balance. Conclusion The described procedure was less invasive because it avoided an anterior approach, yet it yielded satisfactory long-term results for thoracolumbar hemivertebrae.

Abstract: Thirteen patients with progressive congenital scoliosis due to hemivertebrae or hemivertebrae associated with other spinal anomalies were treated by convex anterior and posterior hemiarthrodesis and hemiepiphysiodesis. The average curve prior to operation was 46 degrees, average age was 3 years 6 months, and average followup was 6 years 6 months. One patient failed because of an inadequate length of anterior surgery which was successfully salvaged by further surgery. Twelve patients were successes: Seven had only cessation of the progressive curve, and five had progressive curve improvement greater than or equal to 5 degrees due to the arrested convex and persistent concave growth. This procedure is a valuable treatment modality for selected patients with congenital scoliosis.

Abstract: Study Design. Retrospective review of patients records with clinical and radiographic assessment. Objective. To evaluate the long-term result of thoracolumbar hemivertebrae resection using a double approach in a single procedure. Summary of Background Data. Thoracolumbar hemivertebrae resection by a combined posterior and anterior approach has been previously described, but this is the largest series of hemivertebrae reported. Methods. From 1987 to 2003, a consecutive series of 34 congenital scoliosis or kyphoscoliosis due to thoracolumbar hemivertebrae were managed by hemivertebra resection using a combined posterior and anterior approach and short anterior and posterior convex fusion in the same day/same anesthesia. Results. The mean age at surgery was 3.5 years. The mean follow-up period was 6.0 years. There was a mean improvement of 69.3% in the segmental curve from a mean angle of 34.8 degrees before surgery to 10.7 degrees at the latest follow- up assessment. The global scoliosis curve improved of 33.4% from 40.4 degrees to 26.9 degrees, respectively. Trunk shift was significantly improved. The mean final kyphosis was within normal values. Conclusions. This procedure is safe and offers a persistent correction with a short segment fusion. Surgery should be performed as early as possible to avert severe local deformities and prevent secondary structural deformities in order to avoid extensive fusions.

Abstract: Twenty-four cases of lumbosacral hemivertebrae are reviewed. The treatment groups consisted of observation, bracing, posterior spinal fusion with and without Harrington instrumentation, and two-stage hemivertebral excision. Clinical and radiographic spine decompensation was found to be an important parameter in following these patients. Results with observation and bracing were variable and unpredictable. The best surgical correction was obtained with lumbosacral hemivertebral excision.