HEMIVERTEBRA RESECTION FOR THORACIC AND THORACOLUMBAR CONGENITAL DEFORMITY

Vedat Deviren, MD;
Sigurd Berven, MD;
Arash Emami, MD;
Jason A. Smith, MD;
Serena Hu, MD;
David S. Bradford, MD
UCSF, San Francisco, California, USA

INTRODUCTION:
Hemivertebra resection provides reliable and predictable correction in congenital deformity in the lumbar spine. The increased risk of neurologic impairment with hemivertebrae excision above the conus medullaris has been thought to be excessively high. The purpose of this study is to review the results of hemivertebrae resection for treatment of congenital deformity of the thoracic and thoracolumbar spine.

MATERIAL AND METHODS:
Ten consecutive patients (5 male, 5 female) who had undergone thoracic and thoracolumbar hemivertebra resections were included in this study. Vertebrae resection was performed only anteriorly in two, in whom the posterior elements of the involved hemivertebra were absent. The remainder of the cases involved anterior and posterior resection of the hemivertebra with concomitant fusion. Average age at surgery was 13.4 years (range 6 to 19). Average follow up was 78.5 months ( 20 to 180).

RESULTS:
Average preoperative coronal curve magnitude of 78 degrees (36 to 115) was corrected to 34 degrees (7 to 58) postoperatively, with an average correction of 59%. Preoperative coronal decompensation of 35mm was improved to 11mm postoperatively. Seven patients had significant coronal plane decompensation preoperatively that was corrected to physiologic range postoperatively. There were no major complications and no neurologic compromise post–operatively.

DISCUSSION:
Treatment of congenital deformity secondary to a hemivertebrae which is located at the thoracic and thoracolumbar spine is a challenging surgical problem. We have shown that thoracic and thoracolumbar hemivertebra resection can be performed safely without undue risk of neurological compromise in experienced hands. Based on our experience, we feel that correction and balancing of congenital thoracic or thoracolumbar curves is more effectively achieved with hemlvertebrae resection than with alternative treatments for patients with significant, rigid curves.