Hemivertebrae Resection in the Treatment of Congenital Lumbosacral Scoliosis

  Objective  To summarize the surgical treatment results and discuss the surgical strategy of congenital scoliosis due to lumbosacral hemivertebrae.

  Methods  Totally 877 patients with congenital scoliosis were treated in our hospital between January 2001 and January 2010. Among them, there were 8 cases of lumbosacral hemivertebrae(3 males and 5 females, with the average age at surgery of 11 years old). The clinical data including the anatomic data of hemivertebrae, coronal and saggital Cobb angle, coronal and sagittal trunk shift, surgical approach, and fusion area were retrospectively analyzed for these 8 patients.

  Results  There were 5 full-segmented hemivertebrae and 3 semi-segmented hemivertebrae. Seven patients underwent hemivertebrae resection with posterior approach only, 1 patients underwent hemivertebrae resection with one-stage anterior and posterior approach. The intra-operative blood loss ranged 200-2300 ml(mean:692 ml). The average operation time was 6.5 h. Six patients had short segment fixation and 2 patients had long segment fixation. The mean coronal Cobb angle of lumbosacral curve was 33.1° before surgery, 9.8° after surgery, and 14.0° at latest follow-up. The mean coronal Cobb angle of proximal lumbar curve was 32.5° before surgery, 12.6° after surgery, and 14.2° at latest follow-up. Four patients had coronal trunk imbalance before surgery. The complications included wound dehiscence(n=1) and nerve root injury(n=1). Two patients had malpostion of pedicle screw. One revision surgery was performed. All patients were followed up from 12 to 82 months, with an average follow-up duration of 30.9 months. Coronal trunk shift was improved in 7 patients after surgery, 1 patient had coronal trunk decompensation at final follow-up, and no saggital trunk decompensation was noted.

  Conclusions  Lumbosacral hemivertebrae may cause scoliosis with obvious coronal trunk imbalance, which needs early intervention. The early surgery with hemivertebrae resection and short segment fixation is able to avert severe local deformity and prevent secondary deformity. If the compensatory lumbar curve is severe, extensive fusion is preferred.