Objective To explore the failure cause of posterior approach orthopaedic operation of thoracolumbar hemivertebra, and to summary strategies of revision. Methods The cl inical data from 9 cases undergoing posterior approach orthopaedic operation failure of thoracolumbar hemivertebra between June 2003 and June 2008, were retrospectively analyzed. There were 5 males and 4 females with a median age of 12 years (range, 1 year and 10 months to 24 years). All malformations were identified as fully segmented hemivertebra from the original medical records and X-ray films, including 2 cases in thoracic vertebra, 5 cases in thoracolumbar vertebra, and 2 cases in lumbar vertebra. The preoperative scol iotic Cobb angle was (45.4 ± 17.4)°, and kyphotic Cobb angle was (29.8 ± 22.0)°. The reason of primary surgical failure were analyzed and spinal deformity was corrected again with posterior revision. Results All surgeries were finished successfully. The operation time was 3.0-6.5 hours (mean, 4.5 hours), and the perioperative bleeding was 400-2 500 mL (mean, 950 mL). All incisions healed by first intention; no infection or deep venous thrombosis occurred. Numbness occurred in unilateral lower extremity of 1 case postoperatively, and the symptom was rel ieved completely after treatment of detumescence and neural nutrition. All cases were followed up 12-30 months (mean, 18 months). No pseudoarthrosis and implant failure occurred. The X-ray films showed that the bone grafts completely fused within 8-14 months (mean, 11 months) after operation. The Cobb angles of scol iosis and kyphosis at 1 week after operation and the last follow-up were obviously improved when compared with preoperative ones, showing significant differences (P lt; 0.05). No obvious correction loss was observed either in coronal or sagittal plane. Conclusion The failure causes of posterior approach orthopaedic operation are hemivertebra processing, selection of fixation and fusion range, and selection of internal fixation. If the strategies of revision are made after the above-mentioned failure causes are considered, the cl inical results will be satisfactory.
ObjectiveTo summarize the research progress of one-stage posterior hemivertebra resection for congenital kyphoscoliosis. MethodsThe domestic and foreign related literature about spinal hemivertebra deformity,and many aspects of its operation mode,operation timing,the fixed segment,and operation complications were summarized and analysed. ResultsThe hemivertebra resection can remove teratogenic factors directly,and is favor by the majority of domestic and foreign physicians,but the procedure,indications,long-term effectiveness,and postoperative complications are still unconcern,and the operation timing and fixed-fused segment is still controversial. ConclusionThe operation timing and the fixed segment of one-stage posterior hemivertebra resection for congenital kyphoscoliosis need further research.
ObjectiveTo investigate the effectiveness of selective-partial hemivertebra resection and instrumentation via posterior approach only for congenital kyphoscoliosis. MethodsBetween January 2008 and August 2011, 17 patients with congenital kyphoscoliosis were treated by selective-partial hemivertebra resection and instrumentation via posterior approach. There were 10 boys and 7 girls with the mean age of 10.8 years (range, 9-14 years). Of them, 15 cases had lumbar back pain, and 3 cases had lower limb numbness of nervous system damage symptoms. Risser sign was rated as grade 0 in 3 cases, grade 1 in 2 cases, grade 2 in 7 cases, and grade 3 in 5 cases. The classification of deformity was fully segmental hemivertebra. The deformity located at the thoracic segment in 9 cases, at the thoracolumbar segment in 4 cases, and at the lumbar segment in 4 cases. The Cobb angles of the main curves, segmental curves, and segmental kyphotic curves were measured at pre-operation, at 10 days after operation, and last follow-up to evaluate the correction effect. ResultsThe 2-7 segments (mean, 3.7 segments) were fixed. The operation time was 4-6 hours (mean, 4.77 hours). The intraoperative bleeding was 300-1 100 mL (mean, 611.76 mL). All incisions healed by first intention, with no infection or complication of nervous system. All patients were followed up 6-37 months (mean, 20.12 months). Back pain and numbness of lower limbs were eliminated. X-ray films showed complete bone graft fusion at 6-18 months (mean, 12 months). At 10 days after operation and last follow-up, the Cobb angles of the main curves, segmental curves, and segmental kyphotic curves were significantly decreased compared with the preoperative angles (P<0.05); the Cobb angles of the main curves and segmental curves at last follow-up were significantly greater than those at 10 days after operation (P<0.05) except the segmental kyphotic curves angle (P>0.05). Postoperative correction rates of the Cobb angles of the segmental curve, the main curves, and segmental kyphotic curves were 64.35%±0.07%, 65.08%±0.07%, and 72.26%±0.11%, respectively; loss of correction was (3.04±1.17), (2.81±0.93), and (0.75±0.50)°, respectively. ConclusionFor patients at the age of 9-14 years, with the Risser sign between grade 0-3, and with the Cobb angles less than 60°, the selective-partial hemivertebra resection and instrumentation via posterior approach can balance the growth on the two sides of the spine, and achieve satisfactory therapeutic effect through individualized treatment of extra growth center resection.
Congenital scoliosis is the presence of a sideways curvature of the spine caused by the failure of normal vertebral development. Congenital scoliosis is usually progressive, and surgical treatment is crucial for the treatment of congenital scoliosis. Surgical treatments of congenital scoliosis mainly include simple fusion surgery, hemivertebrae excision, growing rods technique, and vertical expandable prosthetic titanium rib. However, there is no uniform standard for the selection of surgical techniques and surgical timing. This article reviews the progress of different surgical treatments for congenital scoliosis, introduces the classification of congenital scoliosis, and clarifies the timing, pros and cons of different surgical techniques, aiming to provide a reference for the development of individualized optimal surgical plans for patients with congenital scoliosis.