One-stage Posterior Hemivertibral Resection In Treatment For Congenital Spinal Kyphoscoliosis

Objective：To evaluate the effect of operation’s congenital spinal deformity and studyhow to get satisfactory orthopedic effection through grasping surgical opportunity andchoosing the fixed segment.Methods： From the January2001to the June2013，there were44consecutive caseswith congenital scoliosis. The preoperative, postoperative and follow-up were taken thespine X radiographs. Scoliosis, kyphosis and C7PL-CSVL were measured preoperativelyand immediatly postoperatively as well as at the latest follow-up. Calculated theimprovement rate separately. With one-stage posterior hemivertebral resection36cases.22males and14females, Long segment fixation in28cases,short segment fixation in8cases,with the average age at surgery was16.83years ranging from5to48years. According tothe spinal growth,there were four groups，group A (5-8years), group B(9-15years), groupC(16-19years), group D(≥20years). Classification of age and gender comparision oforthopaedic effect. And record the perioperative and long-term complications. Posteriorhemivertebral resection and short segment pedicle screwfixation in8cases(group a),anterior hemivertebral resection of single rod screw fixation in8cases (group b),16cases,male9cases, female7cases; the average age at operation was10.5years ranging from4to15years; orthopedic effect comparison of two operation modes; record of peri operationand complications.Results：All patients were followed up6-110months, average62.9months.36casesof patients with hemivertebral using one-stage posterior hemivertebral resection,8casesthrough anterior hemivertebral resection, all patients were followed up.During follow-up nowound healing, no screw breakage, no pseudarthrosis; one cases head side with newkyphosis, nonunion in one cases, through the second operation,extend the fixed segment,deformity was corrected. Posteriorhemivertebral malformation patients after operation,operation time A, B <D (P <0.05), the amount of intraoperative bleeding A <C <D, A, B < D(P <0.05), fixed segment A, B <C stage (P <0.05). The last follow-up group of A, B, C,D scoliosis Cobb angle correction rate were55±22.61%,63.94±19.84%,63.33±24.11%,74.43±10.08%; the kyphotic Cobb angle correction rate were49.67±15.95%,56.50±36.20%,50.78±28.06%,59.03±30.55%; C7PL-CSVL correction rate were80.70±15.12%,75.58±38.63%,64.66±26.29%,79.17±11.83%; were not differences betweenthe groups (P>0.05); scoliosis Cobb angle at last follow-up corrective rate of female wasbetter than male (P <0.05). Posterior (group a) and anterior (group b) at last follow-up,thescoliosis Cobb angle correction rates were:53.38±21.54%,23.75±21.18%; groups a andb at last follow-up, the kyphotic Cobb angle correction rates were:56.86±11.88%,3.63±20.44%.Group a scoliosis, kyphosis correction and trunk balance recovery better than groupb (P <0.05).Conclusion：One stage posterior hemivertebral resection early is safe and effective,especially for operation before formating of structural compensatory bending and spinalstiffness, which can make the fixed segment and the operation time short, reduceintraoperative hemorrhage. Influence on the growth of the spine and activity is relativelysmall.