IMPACT OF SURGICAL OPPORTUNITY ON EFFECTIVENESS OF POSTERIOR HEMIVERTEBRA RESECTION FOR CONGENITAL SPINAL DEFORMITY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZOUChuanqi , QIUHao , PANYong , ZHOUYue ,  CHUTongwei

Department of Spinal Surgery, Xinqiao Hospital, Third Military Medical University, Chongqing,, P. R. China;

Corresponding author：

CHUTongwei, Email: chtw@sina.com

Keywords：

Scoliosis; Kyphosis; Posterior hemivertebra resection; Bone graft fusion; Internal fixation

DOI：

10.7507/1002-1892.20140106

Video：

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Objective To investigate the optimal surgical opportunity timing of posterior hemivertebra resection by comparing the outcomes of surgical treatment for congenital spinal deformity in patients at different ages. Methods Between January 2007 and Februay 2013, 36 cases of congenital hemivertebra scoliosis underwent one-stage posterior hemivertebra resection and segmental instrumentation fixation and fusion. There were 22 males and 14 females, with an average age of 16.8 years (range, 5-48 years). The patients were divided into 3 groups:group A (≤10 years, n=7), group B (10-20 years, n=22), and group C (>20 years, n=7). There was no significant difference in gender, segment, type, and complication among 3 groups (P>0.05). Anteroposterior and lateral X-ray films were taken before and after operation to measure the scoliosis Cobb angle, kyphosis Cobb angle, and C₇ plumb line-center sacral vertical line (C₇PL-CSVL). The improvement rate was calculated. And the perioperative and long-term complications were recorded. Results The operation time of group A was significantly less than that of group C (P<0.05); the intraoperative blood loss of group B and group C were significantly more than that of group A (P<0.05); and the fixed segments of group B and group C were significantly more than those of group A (P<0.05). Thirty-six cases were followed up 7-62 months (mean, 31.3 months). No poor wound healing, pedicle cutting, pseudoarticulation formation, and other complications occurred during the follow-up. At last follow-up, 31 patients obtained a balance of double shoulders and double hips. The scoliosis Cobb angle, kyphosis Cobb angle, and C₇PL-CSVL at immediate after operation and last follow-up were significantly improved when compared with preoperative ones in 3 groups (P<0.05). The scoliosis Cobb angle at last follow-up of group B was significantly larger than that of group C, the kyphotic correction rate at immediate after operation was significantly larger in groups A and C than in group B, the kyphotic correction rate of group B at last follow-up was significantly less than that of group C, and C₇PL-CSVL correction rate of group A at immediate after operation was significantly larger than that of group B, all showing significant differences (P<0.05). Conclusion Early one stage posterior hemivertebra resection is safe and effective, especially in patients who had no formation of structural compensatory bending and spinal stiffness, which can shorten the operation time and reduce the fixed segments and intraoperative hemorrhage. Influence on the growth and activity of the spine is relatively small.

Citation： ZOUChuanqi, QIUHao, PANYong, ZHOUYue, CHUTongwei. IMPACT OF SURGICAL OPPORTUNITY ON EFFECTIVENESS OF POSTERIOR HEMIVERTEBRA RESECTION FOR CONGENITAL SPINAL DEFORMITY. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(4): 468-473. doi: 10.7507/1002-1892.20140106 Copy

1.	杨锡强, 易著文. 儿科学. 6版. 北京:人民卫生出版社, 2006:4-12.
2.	McMaster MJ, Ohtsuka K.The natural history of congenital scoliosis. A study of two hundred and fifty-one patients. J Bone Joint Surg (Am), 1982, 64(8):1128-1147.
3.	Zhu X, Wei X, Chen J, et al. Posterior hemivertebra resection and monosegmental fusion in the treatment of congenital scoliosis. Ann R Coll Surg Engl, 2014, 96(1):41-44.
4.	Henry H. Transpedicular hemivertebra resection and instrumented fusion for congenital scoliosis. Eur Spine J, 2011, 20(6):993-994.
5.	仉建国, 邱贵兴, 于斌, 等. 后路半椎体切除术治疗先天性脊柱侧后凸的初步结果. 中华骨科杂志, 2006, 26(3):156-160.
6.	王岩, 张永刚, 张雪松, 等. 后路半椎体切除、短节段经椎弓根内固定术治疗小儿先天性脊柱侧凸. 中国脊柱脊髓杂志, 2006, 16(3):196-199.
7.	Ruf M, Jensen R, Letko L, et al. Hemivertebra resection and osteotomies in congenital spine deformity. Spine (Phila Pa 1976), 2009, 34(17):1791-1799.
8.	Winter RB, Burger EL. L₅ hemivertebra resection and T₁₂-S₁ fusion in a 14-year-old female with a 36-year follow-up. Spine (Phila Pa 1976), 2012, 37(7):E445-450.
9.	仉建国, 孙武, 邱贵兴, 等. 后路一期半椎体切除治疗脊柱上胸段侧后凸畸形. 中国脊柱脊髓杂志, 2012, 22(1):49-53.
10.	Obeid I, Bourghli A, Vital JM. Thoracic hemivertebra resection by posterior approach for congenital scoliosis. Eur Spine J, 2013, 22(3):678-680.
11.	Wang S, Zhang J, Qiu G, et al. Posterior hemivertebra resection with bisegmental fusion for congenital scoliosis:more than 3 year outcomes and analysis of unanticipated surgeries. Eur Spine J, 2013, 22(2):387-393.
12.	Winter RB. Congenital thoracic scoliosis with unilateral unsegmented bar, convex hemivertebrae, and fused concave ribs with severe progression after posterior fusion at age 2:40-year follow-up after revision anterior and posterior surgery at age 8. Spine (Phila Pa 1976), 2012, 37(8):E507-510.
13.	Zhang J, Shengru W, Qiu G, et al. The efficacy and complications of posterior hemivertebra resection. Eur Spine J, 2011, 20(10):1692-1702.
14.	Garrido E, Tome-Bermejo F, Tucker SK, et al. Short anterior instrumented fusion and posterior convex non-instrumented fusion of hemivertebra for congenital scoliosis in very young children. Eur Spine J, 2008, 17(11):1507-1514.
15.	Callahan BC, Georgopoulos G, Eilert RE. Hemivertebral excision for congenital scoliosis. J Pediatr Orthop, 1997, 17(1):96-99.
16.	Zarghooni K, Sobotrke R, Schmidt H, et al. Dorsal resection of a thoracic hemivertebra in a 4-year-old boy with endochondral gigantism. A case report. Acta Orthop Belg, 2010, 76(5):699-705.
17.	Peng X, Chen L, Zou X. Hemivertebra resection and scoliosis correction by a unilateral posterior approach using single rod and pedicle screw instrumentation in children under 5 years of age. J Pediatr Orthop B, 2011, 20(6):397-403.
18.	Kose KC, Inanmaz ME, Altinel L, et al. Convex short segment instrumentation and hemichevron osteotomies for Putti type 1 thoracic hemivertebrae:a simple treatment option for patients under 5 years old. J Spinal Disord Tech, 2013, 26(6):E240-247.
19.	Crostelli M, Mazza O, Mariani M. Posterior approach lumbar and thoracolumbar hemivertebra resection in congenital scoliosis in children under 10 years of age:results with 3 years mean follow up. Eur Spine J, 2014, 23(1):209-215.
20.	Ruf M, Harms J. Posterior hemivertebra resection with transpedicular instrumentation:early correction in children aged 1 to 6 years. Spine (Phila Pa 1976), 2003, 28(18):2132-2138.
21.	Xu W, Yang S, Wu X, et al. Hemivertebra excision with short-segment spinal fusion through combined anterior and posterior approaches for congenital spinal deformities in children. J Pediatr Orthop B, 2010, 19(6):545-550.
22.	Yaszay B, O'Brien M, Shufflebarger HL, et al. Efficacy of hemivertebra resection for congenital scoliosis:a multicenter retrospective comparison of three surgical techniques. Spine (Phila Pa 1976), 2011, 36(24):2052-2060.

1. 杨锡强, 易著文. 儿科学. 6版. 北京:人民卫生出版社, 2006:4-12.
2. McMaster MJ, Ohtsuka K.The natural history of congenital scoliosis. A study of two hundred and fifty-one patients. J Bone Joint Surg (Am), 1982, 64(8):1128-1147.
3. Zhu X, Wei X, Chen J, et al. Posterior hemivertebra resection and monosegmental fusion in the treatment of congenital scoliosis. Ann R Coll Surg Engl, 2014, 96(1):41-44.
4. Henry H. Transpedicular hemivertebra resection and instrumented fusion for congenital scoliosis. Eur Spine J, 2011, 20(6):993-994.
5. 仉建国, 邱贵兴, 于斌, 等. 后路半椎体切除术治疗先天性脊柱侧后凸的初步结果. 中华骨科杂志, 2006, 26(3):156-160.
6. 王岩, 张永刚, 张雪松, 等. 后路半椎体切除、短节段经椎弓根内固定术治疗小儿先天性脊柱侧凸. 中国脊柱脊髓杂志, 2006, 16(3):196-199.
7. Ruf M, Jensen R, Letko L, et al. Hemivertebra resection and osteotomies in congenital spine deformity. Spine (Phila Pa 1976), 2009, 34(17):1791-1799.
8. Winter RB, Burger EL. L₅ hemivertebra resection and T₁₂-S₁ fusion in a 14-year-old female with a 36-year follow-up. Spine (Phila Pa 1976), 2012, 37(7):E445-450.
9. 仉建国, 孙武, 邱贵兴, 等. 后路一期半椎体切除治疗脊柱上胸段侧后凸畸形. 中国脊柱脊髓杂志, 2012, 22(1):49-53.
10. Obeid I, Bourghli A, Vital JM. Thoracic hemivertebra resection by posterior approach for congenital scoliosis. Eur Spine J, 2013, 22(3):678-680.
11. Wang S, Zhang J, Qiu G, et al. Posterior hemivertebra resection with bisegmental fusion for congenital scoliosis:more than 3 year outcomes and analysis of unanticipated surgeries. Eur Spine J, 2013, 22(2):387-393.
12. Winter RB. Congenital thoracic scoliosis with unilateral unsegmented bar, convex hemivertebrae, and fused concave ribs with severe progression after posterior fusion at age 2:40-year follow-up after revision anterior and posterior surgery at age 8. Spine (Phila Pa 1976), 2012, 37(8):E507-510.
13. Zhang J, Shengru W, Qiu G, et al. The efficacy and complications of posterior hemivertebra resection. Eur Spine J, 2011, 20(10):1692-1702.
14. Garrido E, Tome-Bermejo F, Tucker SK, et al. Short anterior instrumented fusion and posterior convex non-instrumented fusion of hemivertebra for congenital scoliosis in very young children. Eur Spine J, 2008, 17(11):1507-1514.
15. Callahan BC, Georgopoulos G, Eilert RE. Hemivertebral excision for congenital scoliosis. J Pediatr Orthop, 1997, 17(1):96-99.
16. Zarghooni K, Sobotrke R, Schmidt H, et al. Dorsal resection of a thoracic hemivertebra in a 4-year-old boy with endochondral gigantism. A case report. Acta Orthop Belg, 2010, 76(5):699-705.
17. Peng X, Chen L, Zou X. Hemivertebra resection and scoliosis correction by a unilateral posterior approach using single rod and pedicle screw instrumentation in children under 5 years of age. J Pediatr Orthop B, 2011, 20(6):397-403.
18. Kose KC, Inanmaz ME, Altinel L, et al. Convex short segment instrumentation and hemichevron osteotomies for Putti type 1 thoracic hemivertebrae:a simple treatment option for patients under 5 years old. J Spinal Disord Tech, 2013, 26(6):E240-247.
19. Crostelli M, Mazza O, Mariani M. Posterior approach lumbar and thoracolumbar hemivertebra resection in congenital scoliosis in children under 10 years of age:results with 3 years mean follow up. Eur Spine J, 2014, 23(1):209-215.
20. Ruf M, Harms J. Posterior hemivertebra resection with transpedicular instrumentation:early correction in children aged 1 to 6 years. Spine (Phila Pa 1976), 2003, 28(18):2132-2138.
21. Xu W, Yang S, Wu X, et al. Hemivertebra excision with short-segment spinal fusion through combined anterior and posterior approaches for congenital spinal deformities in children. J Pediatr Orthop B, 2010, 19(6):545-550.
22. Yaszay B, O'Brien M, Shufflebarger HL, et al. Efficacy of hemivertebra resection for congenital scoliosis:a multicenter retrospective comparison of three surgical techniques. Spine (Phila Pa 1976), 2011, 36(24):2052-2060.

Chinese Journal of Reparative and Reconstructive Surgery

IMPACT OF SURGICAL OPPORTUNITY ON EFFECTIVENESS OF POSTERIOR HEMIVERTEBRA RESECTION FOR CONGENITAL SPINAL DEFORMITY

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