Transpedicular hemiepiphysiodesis and posterior instrumentation as a treatment for congenital scoliosis.

Abstract

Anterior and posterior hemiepiphysiodesis using a transpedicular approach is an effective alternative treatment when compared with the traditional convex hemiepiphysiodesis or hemivertebrae excision. No study has reported the results of instrumentation with transpedicular hemiepiphysiodesis. Our study was a retrospective radiographic evaluation to assess the efficacy of transpedicular convex hemiepiphysiodesis with short segment instrumented posterior spinal fusion for congenital scoliosis. Ten hemivertebrae in 9 patients were evaluated. The average patient age was 10.5 years (range, 2.9-14.5 years). The average follow-up was 29.7 months. Cobb angles were recorded for the instrumented segment (segmental main curve) and the global or entire curve (total main curve). These values were compared preoperatively, postoperatively, and at 2-year follow-up. The average total main curve improved in 6 of 10 curves, from 35.0 to 29.6 degrees (15.4%). The average segmental main curve improved in 8 of 10 curves, from 30.0 to 21.5 degrees (28.3%). Seven of 10 curves demonstrated either no progression or improvement at the average 2-year follow-up. Two curves in older patients (greater than 9 years, 10 months) progressed until a comprehensive posterior spinal fusion was required. Multiple surgical techniques have been developed to provide treatment for progressive congenital scoliosis. Transpedicular hemiepiphysiodesis with a short segment instrumented posterior spinal fusion is a safe and effective treatment method to halt the progression of congenital scoliosis due to a hemivertebra in patients who are skeletally immature.