Posterior unilateral pedicle subtraction osteotomy of hemivertebra for correction of the adolescent congenital spinal deformity

摘要

Background context: The treatment of adolescent congenital deformity (late-diagnosed congenital deformity) is still unknown. The best candidates for hemivertebra excision are young patients, typically between 4 and 6 years of age. Partial excision may be feasible for older children. Purpose: The purpose of this study was to assess the effect of unilateral pedicle subtraction osteotomy of hemivertebra for correction of the adolescent congenital spinal deformity. Study design: Retrospective analysis. Patient sample: Twelve patients with adolescent congenital deformity who underwent posterior unilateral pedicle subtraction osteotomy and correction were evaluated. Mean age at the time of surgery was 17 years. Outcome measures: The charts, standing full-length posteroanterior and lateral view radiographs, and functional measures were reviewed. Methods: For evaluation of surgical effectiveness, comparative analysis of the parameters of the total main curve, the segmental curve, the compensatory cranial and caudal curves, the segmental kyphosis, and the trunk shift before and after operation and at the most recent follow-up was done. Results: The mean follow-up period was 40.5 months. Mean Cobb angles of the total main curve and the segmental curve were, respectively, 47.5° and 43.8° before surgery, 23.7° and 16.5° after surgery, and 22.6° and 17° at the last follow-up. The angle of segmental kyphosis was 11.8° before surgery, 6.2° after surgery, and 7.8° (range, -30° to 26°) at the final follow-up. The mean final global lordosis was within the normal range. No neurologic deficit occurred. Solid fusion was achieved for all cases. Conclusions: Unilateral pedicle subtraction osteotomy with instrumentation from a posterior-only approach is indicated in older teenagers for an adolescent congenital spinal deformity. Compared with hemivertebra excision, corrective surgery with hemivertebra osteotomy has a lower intraoperative blood loss and shorter operation time.