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

European Spine Journal volume 25, pages 1567–1574 (2016)Cite this article

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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References

  1. Slabaugh PB, Winter RB, Lonstein JE, Moe JH (1980) Lumbosacral hemivertebrae. A review of twenty-four patients, with excision in eight. Spine (Phila Pa 1976) 5:234–244

  2. Leong JC, Day GA, Luk KD, Freedman LS, Ho EK (1993) Nine-year mean follow-up of one-stage anteroposterior excision of hemivertebrae in the lumbosacral spine. Spine (Phila Pa 1976) 18:2069–2074

  3. Bollini G, Docquier PL, Viehweger E, Launay F, Jouve JL (2006) Lumbosacral hemivertebrae resection by combined approach: medium- and long-term follow-up. Spine (Phila Pa 1976) 31:1232–1239

  4. Zhang J, Shengru W, Qiu G, Yu B, Yipeng W et al (2011) The efficacy and complications of posterior hemivertebra resection. Eur Spine J 20:1692–1702

    Article  PubMed  PubMed Central  Google Scholar 

  5. Li M, Wang CF, Gu SX, He SS, Zhu XD et al (2009) Adapted simplified Chinese (mainland) version of Scoliosis Research Society-22 questionnaire. Spine (Phila Pa 1976) 34:1321–1324

  6. Kesling KL, Lonstein JE, Denis F, Perra JH, Schwender JD et al (2003) The crankshaft phenomenon after posterior spinal arthrodesis for congenital scoliosis: a review of 54 patients. Spine (Phila Pa 1976) 28:267–271

  7. Hall JE, Herndon WA, Levine CR (1981) Surgical treatment of congenital scoliosis with or without Harrington instrumentation. J Bone Joint Surg Am 63:608–619

    CAS  PubMed  Google Scholar 

  8. Marks DS, Iqbal MJ, Thompson AG, Piggott H (1996) Convex spinal epiphysiodesis in the management of progressive infantile idiopathic scoliosis. Spine (Phila Pa 1976) 21:1884–1888

  9. Alanay A, Dede O, Yazici M (2012) Convex instrumented hemiepiphysiodesis with concave distraction: a preliminary report. Clin Orthop Relat Res 470:1144–1150

    Article  PubMed  PubMed Central  Google Scholar 

  10. Walhout RJ, van Rhijn LW, Pruijs JE (2002) Hemi-epiphysiodesis for unclassified congenital scoliosis: immediate results and mid-term follow-up. Eur Spine J 11:543–549

    CAS  Article  PubMed  Google Scholar 

  11. Uzumcugil A, Cil A, Yazici M, Acaroglu E, Alanay A et al (2004) Convex growth arrest in the treatment of congenital spinal deformities, revisited. J Pediatr Orthop 24:658–666

    Article  PubMed  Google Scholar 

  12. Holte DC, Winter RB, Lonstein JE, Denis F (1995) Excision of hemivertebrae and wedge resection in the treatment of congenital scoliosis. J Bone Joint Surg Am 77:159–171

    CAS  PubMed  Google Scholar 

  13. Bollini G, Docquier PL, Viehweger E, Launay F, Jouve JL (2006) Lumbar hemivertebra resection. J Bone Joint Surg Am 88:1043–1052

    Article  PubMed  Google Scholar 

  14. Bollini G, Docquier PL, Viehweger E, Launay F, Jouve JL (2006) Thoracolumbar hemivertebrae resection by double approach in a single procedure: long-term follow-up. Spine (Phila Pa 1976) 31:1745–1757

  15. Nakamura H, Matsuda H, Konishi S, Yamano Y (2002) Single-stage excision of hemivertebrae via the posterior approach alone for congenital spine deformity: follow-up period longer than ten years. Spine (Phila Pa 1976) 27:110–115

  16. Ruf M, Harms J (2002) Hemivertebra resection by a posterior approach: innovative operative technique and first results. Spine (Phila Pa 1976) 27:1116–1123

  17. Wang S, Zhang J, Qiu G, Li S, Yu B et al (2013) Posterior hemivertebra resection with bisegmental fusion for congenital scoliosis: more than 3 year outcomes and analysis of unanticipated surgeries. Eur Spine J 22:387–393

    Article  PubMed  PubMed Central  Google Scholar 

  18. Gaines RW Jr (2000) The use of pedicle-screw internal fixation for the operative treatment of spinal disorders. J Bone Joint Surg Am 82-A:1458–1476

    PubMed  Google Scholar 

  19. An HS, Singh K, Vaccaro AR, Wang G, Yoshida H et al (2004) Biomechanical evaluation of contemporary posterior spinal internal fixation configurations in an unstable burst-fracture calf spine model: special references of hook configurations and pedicle screws. Spine (Phila Pa 1976) 29:257–262

  20. Deviren V, Acaroglu E, Lee J, Fujita M, Hu S et al (2005) Pedicle screw fixation of the thoracic spine: an in vitro biomechanical study on different configurations. Spine (Phila Pa 1976) 30:2530–2537

  21. Nasca RJ, Stilling FH 3rd, Stell HH (1975) Progression of congenital scoliosis due to hemivertebrae and hemivertebrae with bars. J Bone Joint Surg Am 57:456–466

    CAS  PubMed  Google Scholar 

  22. McMaster MJ, Ohtsuka K (1982) The natural history of congenital scoliosis. A study of two hundred and fifty-one patients. J Bone Joint Surg Am 64:1128–1147

    CAS  PubMed  Google Scholar 

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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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    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

    Keywords

    • Congenital scoliosis
    • Lumbosacral hemivertebra
    • One stage
    • Posterior approach
    • Short segmental fusion