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Article: The efficacy and complications of posterior hemivertebra resection

TitleThe efficacy and complications of posterior hemivertebra resection
Authors
Issue Date2011
PublisherSpringer. The Journal's web site is located at http://www.springer.com/medicine/orthopedics/journal/586
Citation
European Spine Journal, 2011, v. 20 n. 10, p. 1692-1702 How to Cite?
Abstract
There have been several reports on hemivertebra resection via a posterior-only procedure. However, the number of reported cases is small, and various types of instrumentation have been used. In our study, we retrospectively investigated 56 consecutive cases of congenital scoliosis that were treated by posterior hemivertebra resection with transpedicular instrumentation. Radiographs were reviewed to determine the type and location of the hemivertebra, the coronal curve magnitude and the sagittal alignment pre-operatively, post-operatively and at the latest follow-up. Radiographs were also used to assess implant failure and inter-body fusion. Surgical reports and patient charts were reviewed to record any peri-operative complications. Fifty-eight posterior hemivertebrae resections from 56 patients aged 1.5-17 years with fully segmented non-incarcerated hemivertebra were evaluated. The average age at surgery was 9.9 years (1.5-17 years). The average follow-up was 32.9 months (24-58 months). The mean fusion level was 5.0 segments (2-11 segments). There was a mean improvement of 72.9% in the segmental scoliosis, from 42.4° before surgery to 12.3° at the time of the latest follow-up, and there was a mean improvement of 70% in segmental kyphosis from 42.0° to 14.5° over the same time period. The thoracic kyphosis (T5-T12) averaged 10.8° before surgery and 23.9° at the latest follow-up. The lumbar lordosis (L1-S1) averaged -52.8° before surgery and -51.6° at the latest follow-up. Two cases with neurological claudications had complete recovery immediately after the surgery. There was one case of delayed wound healing, two fractures of the pedicle at the instrumented level, two rod breakages and one proximal junction kyphosis that required revision. There were no neurological complications. Radiolucent gaps were found in the residual space after resection on the lateral view in five cases, without any sign of implant failure or correction loss. Our results show that one-stage posterior hemivertebra resection with transpedicular instrumentation can achieve excellent correction, 360° decompression and short fusion without neurological complications. Pedicle cutting still remains a challenge in younger children when using bisegmental instrumentation. In addition, the radiolucent gaps in the residual space require further investigation. © The Author(s) 2011.
Persistent Identifierhttp://hdl.handle.net/10722/170190
ISSN
2013 Impact Factor: 2.473
ISI Accession Number ID
References

 

Author Affiliations
  1. The University of Hong Kong
  2. Peking Union Medical College
DC FieldValueLanguage
dc.contributor.authorZhang, Jen_US
dc.contributor.authorShengru, Wen_US
dc.contributor.authorQiu, Gen_US
dc.contributor.authorYu, Ben_US
dc.contributor.authorYipeng, Wen_US
dc.contributor.authorLuk, KDKen_US
dc.date.accessioned2012-10-30T06:05:59Z-
dc.date.available2012-10-30T06:05:59Z-
dc.date.issued2011en_US
dc.identifier.citationEuropean Spine Journal, 2011, v. 20 n. 10, p. 1692-1702en_US
dc.identifier.issn0940-6719en_US
dc.identifier.urihttp://hdl.handle.net/10722/170190-
dc.description.abstractThere have been several reports on hemivertebra resection via a posterior-only procedure. However, the number of reported cases is small, and various types of instrumentation have been used. In our study, we retrospectively investigated 56 consecutive cases of congenital scoliosis that were treated by posterior hemivertebra resection with transpedicular instrumentation. Radiographs were reviewed to determine the type and location of the hemivertebra, the coronal curve magnitude and the sagittal alignment pre-operatively, post-operatively and at the latest follow-up. Radiographs were also used to assess implant failure and inter-body fusion. Surgical reports and patient charts were reviewed to record any peri-operative complications. Fifty-eight posterior hemivertebrae resections from 56 patients aged 1.5-17 years with fully segmented non-incarcerated hemivertebra were evaluated. The average age at surgery was 9.9 years (1.5-17 years). The average follow-up was 32.9 months (24-58 months). The mean fusion level was 5.0 segments (2-11 segments). There was a mean improvement of 72.9% in the segmental scoliosis, from 42.4° before surgery to 12.3° at the time of the latest follow-up, and there was a mean improvement of 70% in segmental kyphosis from 42.0° to 14.5° over the same time period. The thoracic kyphosis (T5-T12) averaged 10.8° before surgery and 23.9° at the latest follow-up. The lumbar lordosis (L1-S1) averaged -52.8° before surgery and -51.6° at the latest follow-up. Two cases with neurological claudications had complete recovery immediately after the surgery. There was one case of delayed wound healing, two fractures of the pedicle at the instrumented level, two rod breakages and one proximal junction kyphosis that required revision. There were no neurological complications. Radiolucent gaps were found in the residual space after resection on the lateral view in five cases, without any sign of implant failure or correction loss. Our results show that one-stage posterior hemivertebra resection with transpedicular instrumentation can achieve excellent correction, 360° decompression and short fusion without neurological complications. Pedicle cutting still remains a challenge in younger children when using bisegmental instrumentation. In addition, the radiolucent gaps in the residual space require further investigation. © The Author(s) 2011.en_US
dc.languageengen_US
dc.publisherSpringer. The Journal's web site is located at http://www.springer.com/medicine/orthopedics/journal/586en_US
dc.relation.ispartofEuropean Spine Journalen_US
dc.subject.meshAdolescenten_US
dc.subject.meshAdulten_US
dc.subject.meshChilden_US
dc.subject.meshChild, Preschoolen_US
dc.subject.meshFemaleen_US
dc.subject.meshFollow-Up Studiesen_US
dc.subject.meshHumansen_US
dc.subject.meshInfanten_US
dc.subject.meshMaleen_US
dc.subject.meshPostoperative Complications - Diagnosis - Etiologyen_US
dc.subject.meshRetrospective Studiesen_US
dc.subject.meshScoliosis - Congenital - Surgeryen_US
dc.subject.meshSpinal Fusion - Adverse Effects - Methodsen_US
dc.subject.meshTreatment Outcomeen_US
dc.titleThe efficacy and complications of posterior hemivertebra resectionen_US
dc.typeArticleen_US
dc.identifier.emailLuk, KDK:hcm21000@hku.hken_US
dc.identifier.authorityLuk, KDK=rp00333en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.doi10.1007/s00586-011-1710-0en_US
dc.identifier.pmid21318279en_US
dc.identifier.scopuseid_2-s2.0-84855204962en_US
dc.identifier.hkuros207331-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-84855204962&selection=ref&src=s&origin=recordpageen_US
dc.identifier.volume20en_US
dc.identifier.issue10en_US
dc.identifier.spage1692en_US
dc.identifier.epage1702en_US
dc.identifier.isiWOS:000294907500017-
dc.publisher.placeGermanyen_US
dc.identifier.scopusauthoridZhang, J=36953527700en_US
dc.identifier.scopusauthoridShengru, W=36953418400en_US
dc.identifier.scopusauthoridQiu, G=7103291762en_US
dc.identifier.scopusauthoridYu, B=36099782400en_US
dc.identifier.scopusauthoridYipeng, W=7801685308en_US
dc.identifier.scopusauthoridLuk, KDK=7201921573en_US
dc.identifier.citeulike8919814-

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