Long-term Efficacy Analysis Of Single Posterior Hemivertebrectomy Combined With Short-segment Fixation In The Treatment Of Children With Congenital Lumbosacral Hemivertebra Deformity

Chapter 1The radiographic outcomes of one-stage posterior-only hemivertebra resection and short segmental fusion for congenital scoliosis secdondary to lumbosacral hemivertebra:a minimum of 5-year follow-upBackground Previous studies have reported satisfied short-term outcomes after one-stage posterior-only hemivertebra resection and short segmental fusion in congenital scoliosis(CS)patients secondary to lumbosacral hemivertebra(LSHV)However,there is a paucity of study evaluating the long-term outcomes following this procedure.Objective To investigate the long-term radiographic outcomes and complications of one-stage posterior-only LSHV resection with short segmental fusion for the treatment of CS patients secondary to LSHV with a minimum of 5 years follow-upMethods Young CS patients secondary to LSHV who were treated by one-stage posterior-only LSHV resection and short segmental fusion between March 2003 and February 2017 and experienced a more than 5-year follow-up were reviewed retrospectively.Radiological parameters including Cobb angle of lumbosacral curve(LSC)and compensatory curve(CC),upper instrumented vertebra(UIV)tilt,coronal balance distance(CBD)and lumbosacral lordosis(LSL),thoracic kyphosis(TK),lumbar lordosis(LL)and sagittal vertical axis(SVA)were measured on the standing whole spine X-rays before surgery,immediately after surgery,2-year after surgery and at the last follow-up.The complications were recorded accordinglyResults Finally,a total of 21 patients were recruited.The mean duration of follow-up was 6.5±2.4 years and the average age at surgery was 8.4±2.9 years.Fusion levels averaged 2.9±0.6 segments.The lumbosacral curve was corrected from 29.8± 10.1° before surgery to 6.5±5.1° after surgery(p<0.001),7±5.4° at 2 years after surgery,and 7.8±6.1° at the last follow-up,respectively.The compensatory curve was spontaneously corrected from 22.9± 11.1° before surgery to 8.5±5.2°immediately after surgery(p<0.001),10.1 ±6.0° at two years after surgery and 11.9±6.5° at the last follow-up.Coronal trunk shift was improved from 24.5± 14.2mm before surgery to 14.6± 11.9mm immediately after surgery(p<0.01),12.0±8.9mm at two years after surgery and 9.8±8.0mm at the last follow-up.No significant differences were observed regarding to sagittal parameters(p value all>0.05).One patient was observed with pedicle fracture during the surgery.One patient experienced transient neurologic deficit after surgery and completely recovered 3 months laterConclusions One-stage posterior-only hemivertebra resection with short segmental fusion is an effective procedure for CS secondary to LSHV and the correction can be well maintained during the longitudinal follow-up.Chapter 2The upper instrumented vertebra horizontalization: an essential factor predicting the spontaneous correction of compensatory curve after lumbosacral hemivertebra resection and short fusionStudy Design.A retrospective studyObjective.To determine the significance of postoperative upper instrumented vertebra(UIV)horizontalization on the evolution of proximal compensatory curve after hemivertebra resection and short fusion in young patients with lumbosacral hemivertebra(LSHV)Summary of Background Data.Postoperative compensatory curve progression(CCP)is an undesired complication in patients undergoing spinal fusion Posterior-only hemivertebra resection and short fusion has gradually become a preferred treatment for young patients with LSHV Postoperative UIV horizontalization might play an important role in the evolution of compensatory curve after surgeryMethods.This study reviewed a consecutive series of patients undergoing posterior-only LSHV resection and short fusion from August 2006 to June 2016.The radiographic parameters were measured at pre-operation,immediately post-operation and the last follow-up.Based on the immediately postoperative UIV tilt,patients were divided into horizontal group(UIV tilt<5°)and inclined group(UIV tilt≥5°)Postoperative CCP was defined as the Cobb angle of compensatory curve increased more than 10° than the immediately postoperative valueResults.Forty-eight patients(8.1±3.4 years)were recruited.Seventeen patients with immediately postoperative UIV tilt≥5° constituted the inclined group,while the other 31 patients were in horizontal group.The two groups had similar age,fusion levels,preoperative spinal curvatures and sagittal profiles.Compared with horizontal group,patients in inclined group had greater CBD(20.7± 14.8mm vs.13.2±9.9mm,P=0.041)and greater Cobb angle of compensatory curve(17.7±8.2° vs.9.1 ±5.3°,P<0.001)at the last follow-up.Thirteen patients of inclined group experienced postoperative CCP,which was more prevalent than that in horizontal group(76.5%vs.9.7%,P<0.001)Conclusions.Horizontalizing the UIV can reduce the risk of postoperative CCP in LSHV patients undergoing posterior-only hemivertebra resection and short fusion.