Posterior-only Hemivertebra Resection With Anterior Structural Reconstruction With Titanium Mesh Cage and Short Segmental Fusion for the Treatment of Congenital Scoliokyphosis: The Indications and Preliminary Results.

Abstract

MINI: Posterior hemivertebra resection with anterior structural reconstruction and short segmental fusion may be a reliable procedure for selected patients with scoliokyphosis due to a hemivertebra, providing good correction both on the coronal and sagittal planes, saving mobile segments with lower risk of implants failures. Perspective study. To evaluate indications and preliminary results of posterior hemivertebra resection with anterior structural reconstruction with titanium mesh cage and short segmental fusion. There exist a lot of reports on posterior hemivertebra resection for the early surgical intervention of congenital scoliosis because of hemivertebra. However, a few reports describe the procedure of the anterior structural reconstruction after posterior hemivertebra resection. In this study, 18 selected children of mean age 5.4 years (range, 2-12 yrs) with scoliokyphosis because of hemivertebra were treated with posterior hemivertebra resection with anterior structural reconstruction and short segmental fusion. They were followed for an average of 37.1 (24-85) months. Radiograghs, operative reports, and patient charts were studied to evaluate the correction and complications. Average fused segments were 1.67 (1-3). The segmental scoliosis was 40.1° before surgery, 4.1° postsurgery, and 5.7° at the latest the follow up. Moreover, the segmental kyphosis (difference to normal segmental alignment) was improved from 27.6° to 3.9°. The correction of the compensatory cranial and caudal curve was 74.7% and 82.4%. The trunk shift improved from 17.7 mm to 5.3 mm. No complications occurred until the latest follow up. Posterior hemivertebra resection with anterior structural reconstruction and short segmental fusion is a reliable procedure for selected patients with scoliokyphosis because of hemivertebra. A structural reconstruction is essential to the avoidance of overcorrection of the segmental scoliosis and resultant postoperative coronal imbalance with limited fused levels in some patients, increasing chances of short segmental fusion and saving mobile segments. As a fulcrum, anterior reconstruction with a titanium mesh cage could help to improve the correction of segmental kyphosis. Furthermore, the cage may help to stabilize the level of hemivertebra resection like a structural autograft, enhancing the postoperative stability and decreasing the stress of the pedicle and implants. 4.