Posterior Hemivertebra Resection with Transpedicular Instrumentation Early Correction in One to Six Year old Children

Corrective surgery in older children and adults with congenital scoliosis most frequently requires a multilevel fusion including secondary structural curves. Therefore, therapy should start as early as possible to allow for a short fusion and to avoid secondary structural changes. The purpose of the current study was to review retrospectively a consecutive series of hemivertebra resections with transpedicular instrumentation in one to six year old children.

From June 1991 to September 2001, we performed 28 hemivertebra resections in 25 children. Mean age at time of surgery was 3 years 4 months (range 1 year 3 months to 6 years 11 months). By posterior approach, the hemivertebra and, in thoracic spine, the rib head at the convex side were removed. 3.5 mm pedicle screws were placed in the adjacent vertebrae and compression was applied to close the gap on the convex side.

Mean follow up time was 3 years and 1 month (range 6 months to 8 years 8 months). Cobb angle of the main curve was an average of 45.3° and improved to 14.4° postoperatively. Cobb angle at the latest follow up was an average of 12.9°. Kyphosis angle improved from 23.6° to 11.8° postoperatively to 10.6° at last follow up. The secondary curves which were not included in the fusion improved as well. Secondary cranial curve had an average of 16.7° preoperatively, 4.9° postoperatively and 3.9° at latest follow up. Secondary caudal curve 21.6° preoperatively, 7.9° postoperatively and 7.3° at last follow up. There were no major complications; in particularly no persisting neurological deficits.

In summary, posterior resection of hemivertebrae with transpedicular instrumentation is a safe and efficient procedure to correct congenital deformity early in young children. An excellent correction of the main curve is achieved with short fusion. The secondary cranial and caudal curves, which are not included in the fusion, are nearly completely corrected. Short segment fusion and excellent correction of the main curve as well as the secondary curves allow the spine a nearly normal growth. In our experience, corrective surgery of congenital deformity should be performed as early as possible.