Efficacy of Hemivertebra Resection for Congenital Scoliosis

In Brief Study Design. Multicenter, retrospective study. Objective. To compare the outcomes of three surgical treatments for congenital spinal deformity due to a hemivertebra. Summary of Background Data. Congenital anomalies of the spine can cause significant and progressive scoliosis and kyphosis. Their management may be challenging and controversy remains over the “best” surgical treatment. Methods. A multicenter retrospective study of patients with congenital spinal deformity due to 1 or 2 level hemivertebra(e) was performed. The surgical treatments included hemiepiphysiodesis or in situ fusion (group 1), instrumented fusion without hemivertebra excision (group 2), or instrumented hemivertebra excision (group 3). Results. Seventy-six patients with minimum 2-year follow-up were evaluated. The mean age was 8 years (range: 1–18). The hemivertebra were fully segmented, nonincarcerated (67%), incarcerated (1%), and semisegmented (32%). There were 65 patients with single hemivertebra and 11 patients with double hemivertebra. There were 14 (18.4%) group 1, 20 (26.3%) group 2, and 42 (55.3%) group 3 patients. Group 1 (37 ± 14°) and group 3 (35 ± 26°) patients had smaller preoperative curves than group 2 patients (55 ± 26°) (P < 0.01). Group 3 had better percent correction at 2 years than groups 1 and 2 (P < 0.001). Group 3 had shorter fusion (P = 0.001), less estimated blood loss (EBL, P = 0.03), and a trend toward shorter operative times than group 2 (P = 0.10). The overall complication rate for the entire group was 30% group 1 (23%), group 2 (17%), and group 3 (44%) (P = 0.09). Conclusion. While hemivertebra resection for congenital scoliosis had a higher complication rate than either hemiepiphysiodesis/in situ fusion or instrumentated fusion without resection, posterior hemivertebra resection in younger patients resulted in better percent correction than the other two techniques. Three surgical treatments for congenital scoliosis due to hemivertebrae were evaluated in 76 patients. Hemivertebra resection resulted in greater correction with shorter fusions and less EBL. However, there was a higher rate of instrumentation failure and neurologic complications associated with a hemivertebrectomy.