Long-term results of hemivertebra excision: How does the spine behave after the peak of puberty?
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Long‑term results of hemivertebra excision: How does the spine behave after the peak of puberty? Piantoni Lucas1 · Carlos A. Tello1 · Rodrigo G. Remondino1 · Carlos Moyano1 · Ida AFrancheri Wilson1 · Eduardo Galaretto1 · Ernesto S. Bersusky1 · Mariano A. Noel1 Received: 21 April 2020 / Accepted: 25 August 2020 © Scoliosis Research Society 2020
Abstract Introduction Early hemivertebra (HV) excision and posterior spinal fusion (PSF) is advocated as the treatment of choice in congenital kyphoscoliosis. We assessed global spinal balance and spinal deformity status once the pubertal peak has taken place, in children with a history of HV excision and PSF at age younger than 5 years. Methods Twenty-seven children with congenital kyphoscoliosis without co-existing proximal/distal congenital spinal abnormalities who underwent HV excision and PSF of ≤ 5 levels at age younger than 5 years and who had reached the peak of puberty at the last follow-up visit were evaluated. Results Twenty-seven HV excision were performed. Mean age at surgery was 3 years and 2 months. A mean of 3.2 segments were fused. Imbalance of the trunk was observed in 80% of thoracic and 75% of thoracolumbar HV excision. No arthrodesis technique (4 cases) presented 100% of spine decompensation. All children younger than 2 years at the time of surgery developed spinal imbalance. Eighteen patients (67%) had global spine imbalance; 81% male population and 63% of the female population. Mean age at surgery was 3 years + 2 months. Mean age of the patients at the time of the study was 15 years + 5 months. Mean follow-up was 12 years + 3 months. Conclusion Many of these patients developed spinal imbalance and scoliosis worsened at the final follow-up. Early age at surgery, preoperative scoliosis severity, HV location, no arthrodesis technique, and the adding-on phenomenon may be involved. Keywords Hemivertebra excision · Congenital scoliosis · Pediatric spine · Spine surgery
Introduction Although successful outcomes of hemivertebra (HV) excision and posterior spinal fusion (PSF) for congenital kyphoscoliosis have been reported, there are a few studies on the medium- and long-term results, especially in children Electronic supplementary material The online version of this article (https://doi.org/10.1007/s43390-020-00198-y) contains supplementary material, which is available to authorized users.
younger than 5 years at the time of surgery [1, 2]. Coronal and sagittal balance in the long-term follow-up of PSF after the peak of puberty has been scarcely assessed in the literature. Congenital kyphoscoliosis is a failure of vertebral formation, segmentation, or a combination of both during weeks 3–6 of gestation that may result in abnormal vertebral development. The spinal deformity can be of variable severity leading to a stable or a progressive deformity based on the
* Piantoni Lucas [email protected]
Eduardo Galaretto [email protected]
Carlos A. Tello [email protected]
Ernesto S. Bersusky [email protected]
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