RESUMO
Objective: We sought to determine whether a posterior vertebral resection on congenital deformities of thoracolumbar and lumbar vertebrae leads to more complications and provides less correction. Methods: Twenty-three patients underwent a posterior vertebral resection for a rigid congenital spinal deformity, which included scoliosis (13 patients), kyphoscoliosis (6 patients), and pure kyphosis (4 patients). The surgeries involved removing 1 to 2 vertebrae using multiaxial pedicle screws in all but 2 of the patients. All surgeries were performed under intraoperative spinal cord monitoring. Thoracic curve, lumbar lordosis, focal kyphosis, shift, and sagittal vertical axis were collected at baseline and during the last follow-up (taking place after at least 3 years) and were then statistically analyzed. Results: The major curve correction was about 55% in cases of scoliosis, with focal kyphosis improving from 54.3 ± 19.1 degrees to 21.3 ± 15 degrees. Two patients experienced intraoperative neuromonitoring changes, with data returning to baseline without any surgical intervention. Sensory or motor palsy after the surgery was not reported in patients.Despite improving sagittal or coronal deformities, 8 patients experienced excessive sagittal decompensation during follow-up, 1 of whom underwent revision surgery. Sagittal decompensation was by far the most common complication. Larger kyphoscoliosis or focal kyphosis angles were preoperative risk factors for postoperative sagittal imbalance (P value < 0.05). Conclusions: Using a lumbar or thoracolumbar posterior vertebral resection enables surgeons to correct rigid curves in the pediatric population without major risk to nerve roots. The primary complications would be sagittal decompensation and the likelihood of undercorrection, which requires mindful addressing during the preoperative planning stages.
RESUMO
STUDY DESIGN: Retrospective clinical and radiologic evaluation of a single-stage partial corpectomy of the hemivertebra with anterior instrumentation and simultaneous posterior noninstrumented fusion. OBJECTIVE: To determine the safety and efficacy of a new technique in the management of progressive congenital spinal deformities due to failure of formation in the very young age. SUMMARY OF BACKGROUND DATA: Several techniques have been reported for the surgical treatment of young children with congenital spinal deformities. There have been concerns regarding epidural bleeding, neurologic complications, pedicle screws placement, implant failure, and prominence of posterior constructs in this very young age group. A single-stage partial corpectomy of the hemivertebra with anterior instrumentation and simultaneous posterior noninstrumented fusion can offer a new alternative which can avoid these concerns. METHODS: Twelve patients with progressive congenital spinal deformities due to failure of formation were retrospectively reviewed after adopting the above mentioned technique. All patients included in the study presented with a single hemivertebra. The mean age at time of surgery was 2 years 7 months (range, 1 year and 9 months to 3 years and 10 months). The average follow-up period was 3 years and 1 month (range, 2 years to 4 years and 5 months). RESULTS: There were no cases of intra or postoperative neurologic or implant related complications. There was 1 superficial infection. All patients showed solid radiologic fusion. The mean scoliosis angle improved from 48.3° (range, 34°-58°) preoperative to 17.2° (range, 11°-25°). The mean angle of kyphosis improved from 23.2° (range, 16°-57°) before surgery to 11.7° (range, 4°-16°). CONCLUSION: A single-stage partial corpectomy of the hemivertebra with anterior instrumentation and simultaneous posterior noninstrumented fusion offers a safe alternative method in treating patients with congenital hemivertebra under the age of 4 years.