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One-stage posterior-only lumbosacral hemivertebra resection with short segmental fusion: a more than 2-year follow-up

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Abstract

Introduction

Lumbosacral hemivertebra poses a unique problem because it can cause gross imbalance and progressive compensatory thoracolumbar deformity. Previous studies have reported lumbosacral hemivertebra resection through a combined anterior and posterior approach, but there have been no reports on the results and complications of hemivertebra resection via a posterior-only procedure and short fusion with large series of patients.

Materials and methods

This retrospective study of a prospective collected database comprises a consecutive series of 14 congenital scoliosis due to lumbosacral hemivertebra treated by 1-stage posterior hemivertebra resection with short segmental fusion, with at least a 2-year follow-up period (24–144 months). Surgical reports and patient charts were reviewed. Radiographic evaluation included measured changes in segmental scoliosis and lordosis, compensatory scoliosis, thoracic kyphosis, lumbar lordosis, and trunk shift. Quality of life data from Scoliosis Research Society (SRS)-22 questionnaires were also collected.

Results

Our results showed that the mean follow-up period was 38.4 months. The mean fusion level was 3.2 segments. Mean operation time was 207.8 min with the average blood loss of 235.7 ml. The mean segmental scoliosis was 30° preoperatively, 5° postoperatively (83 % correction rate), and 4° (87 %) at the latest follow-up. The compensatory coronal curve of 30° was spontaneously corrected to 13° at most recent follow-up. Trunk shift was significantly improved on both coronal (63 %) and sagittal plane (58 %) after the surgery, and kept stable during the follow-up. The total SRS-22 score, the self-image domain score and the satisfaction domain score demonstrated significant improvement compared with preoperative status. Only one intra-operative complication was observed, a pedicle fracture.

Conclusions

In summary, our results showed that one-stage HV resection and short segment fusion by a posterior approach can offer excellent scoliosis correction and trunk shift improvement without neurological complications, while saving motion segments as much as possible. This strategy is not only corrective of the deformity but also preventive of compensatory curve progression, thus avoiding long lumbar fusion.

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Acknowledgments

This work was supported by the National Natural Science Foundation of China (81272054, 81171673).

Conflict of interest

None of the authors has any potential conflict of interest.

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    Authors and Affiliations

    1. Department of Orthopedics, Peking Union Medical College Hospital, No. 1 Shuai Fu Yuan, Wang Fu Jing Street, Beijing, 100730, China

      Qianyu Zhuang, Jianguo Zhang, Shugang Li, Shengru Wang, Jianwei Guo & Guixing Qiu

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    1. Qianyu Zhuang
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    2. Jianguo Zhang
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    3. Shugang Li
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    4. Shengru Wang
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    5. Jianwei Guo
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    Correspondence to Jianguo Zhang.

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    Q. Zhuang and J. Zhang contributed equally to this paper.

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    Zhuang, Q., Zhang, J., Li, S. et al. One-stage posterior-only lumbosacral hemivertebra resection with short segmental fusion: a more than 2-year follow-up. Eur Spine J 25, 1567–1574 (2016). https://doi.org/10.1007/s00586-015-3995-x

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    • DOI: https://doi.org/10.1007/s00586-015-3995-x

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