Posterior Hemivertebrae Resection in Adolescent Thoracolumbar Congenital Kyphoscoliosis

Background: Because of hemivertebrae in thoracolumbar region, it is too difficult to correct this kind of rigid kyphoscoliosis by routing methods. Vertebrectomy should be requested to correct spinal deformity. However, the risk of surgery in this region has been encountered, so combined anterior and posterior approach has been advocated. Alone posterior vertebrectomy in thoracolumbar region has been controversial.

Objective: To analyze the risks of posterior hemivertebrae resection in adolescent thoracolumbar kyphoscoliosis and review the clinical and radiographic results.

Methods: 28 patients suffered from single congenital hemivertebrae in thoracolumbar region. 12 hemivertebra were located in T12, 10 in L1 and 6 in T11. Cobb measurement was 75º (50-98º) in kyphosis and 48º (32-60º) in scoliosis. Among them, 19 were male and 9 were female with average age 14 years (12-17y) at surgery. These deformities were corrected by posterior hemivertebra resection. Surgical technique was summarized that removing the discs above and below hemivertebra after hemivertebra resection was performed posteriorly using all kinds of different curets and then closing the space after grafting into it using bone from resected vertebrae.

Results: Intercostal neuralgia occured in one patients with automatic relieve of no any treatment. Dura tearing happened in two patients without any neurologic problems and healed after removing tube. These patients were followed up for mean 3.5 years (2.2-4.3y). Solid fusion had been gained in all the patients. Cobb measurement was average of 19º (5-30º) in kyphosis and 14º (5-24º) in scoliosis at the final followup. No any neurological deficit and infection was noted in late stage. Clinically, no spinal imbalance or trunk shift was observed in all patients.

Conclusion: In correction of adolescent congenital kyphoscoliosis, posterior hemivertebra resection is safety and effective without any severe neurological or other complications.