Comparison of Anterior/Posterior and Posterior Only Approaches for Hemivertebrae Excision in Congenital Scoliosis

Purpose: This study compares anterior/posterior and posterior only approaches for hemivertebrae excision in congenital scoliosis.

Methods: Six cases using a posterior only (Group I) and 12 an anterior/posterior (Group II) approach with a 2-year minimum follow-up were identified. Preoperative, postoperative, and most recent records and radiographs were reviewed for hemivertebrae and fusion levels, associated curvatures and anomalies, operative time, blood loss, and complications.

Findings: Mean age was 5.1 and 9.2 years, mean preoperative coronal plane deformity 31.6 and 47.6 degrees, and mean follow-up 5.9 and 4.7 years in Groups I and II, respectively. At last follow-up, mean coronal plane deformity was 23 and 22.7 degrees; and mean corrections were 95% and 41.4% for segmental kyphosis, and 1.5 and 0.8 cm for lateral decompensation in Groups I and II, respectively. Mean operative time was 4.5 and 8.2 hours, mean blood loss 424 and 1041 cc, and mean fused vertebrae 3.1 and 6.3 in Groups I and II, respectively. One revision was made for coronal decompensation in Group I and two in Group II. There were 6 spinal cord pathologies confirmed by MRI preoperatively but no pseudarthrosis or neurologic complications occurred.

Significance: Both anterior/posterior and posterior only approaches to hemivertebrae excision in congenital scoliosis achieve excellent deformity correction. This study provides approach selection guidelines for hemivertebrae excision.