One-stage posterior excision of hemivertebrae for the treatment of congenital thoracic-lumbar kyphoscoliosis of multiple hemivertebraes

XUE Jingbo; WANG Wenjun; YAN Yiguo; WANG Cheng; WANG Lushan; LIU Lile

doi:10.3969/j.issn.1674-666X.2013.03.001

Abstract：Objective To evaluate the outcome of one-stage posterior hemivertebrae resection and internal fixation for the treatment of congenital thoracic-lumbar kyphoscoliosis of multiple hemivertebraes. Methods From June 2005 to December 2012, nine consecutive patients with thoracic-lumbar kyphoscoliosis of multiple hemivertebraes were treated in the First Affiliated Hospital of University of South China. There were a total of 21 hemivertebraes, including 3 patients with 3 hemivertebraes and 6 patients with two hemivertebraes, in which 14 fully segmented hemivertebraes and 7 incomplete segmented hemivertebraes. One-stage posterior hemivertebrae resection and internal fixation was performed in all cases. Long cassette standing radiographs were taken to measure the coronal scoliotic Cobb angle and sagittal kyphotic Cobb angle at preoperation, postoperation and the final follow-up. Results The average follow-up was 24.8 months ranging from 7 to 52 months. The average operative time was 326 min (210-450 min) with a mean 1 950 mL (1 200-3 800 mL) of estimate blood loss. The scoliosis was corrected from preoperative (47 ± 10)° to postoperative (14 ± 4)° , the kyphosis was corrected from preoperative (28 ± 4)° to postoperative (11 ± 4)° , the difference between preoperation and postoperation had statistical significance (P <0.05). At the final follow-up, there was no obvious loss of correction. Leakage of cerebrospinal fluid occurred in 1 case was cured by lengthening incision drainage time, neurological deficit with numbness and distending pain in lower limb occurred in 1 case was resolved in 3 months. Bony fusion was obtained in all patients at 6 month's follow up. No infections, hardware failure or spinal pseudoarthrosis had happened. Conclusion One-stage posterior hemivertebrae resection and internal fixation is a reasonable surgical option for patients with congenital thoracic-lumbar kyphoscoliosis of multiple hemivertebraes.