The Journal of Bone and Joint Surgery, Vol 77, Issue 2 159-171, Copyright © 1995 by Journal of Bone and Joint Surgery, Inc
Excision of hemivertebrae and wedge resection in the treatment of congenital scoliosis
DC Holte, RB Winter, JE Lonstein and F Denis
Minnesota Spine Center, Minneapolis 55454-1419.
The results of anterior and posterior excision or wedge resection of a
hemivertebra and arthrodesis of the spine were reviewed retrospectively for
thirty-seven patients. The degree of correction that was obtained and
maintained, the balance and alignment of the trunk, changes in pelvic
obliquity, and associated complications were evaluated. The average age at
the time of the operation was twelve years (range, six months to forty-two
years). The average duration of follow-up was six years (range, two to
nineteen years). The resection was at the mid-thoracic level in six
patients, at the thoracolumbar level in nine, at the mid-lumbar level in
seven, and at the lumbosacral level in seventeen. (Two patients had an
excision of a hemivertebra at two levels.) Instrumentation was used in
twenty-eight patients. Postoperatively, all patients were managed with a
body cast, with a unilateral or bilateral pantaloon extension, for four to
six months. The instrumentation allowed early walking and the use of a
unilateral rather than a bilateral pantaloon extension. The index curve
(the curve containing the hemivertebra) averaged 54 degrees (range, 18 to
132 degrees) preoperatively, 33 degrees (range, 0 to 105 degrees)
postoperatively, and 35 degrees (range, 0 to 110 degrees) at the most
recent follow-up evaluation. A measurable improvement in balance was
achieved and maintained in nineteen patients. Pelvic obliquity did not
change appreciably, as it was related primarily to limb-length inequality
in this series. Complications included a temporary nerve-root lesion in
seven patients, a permanent neurological deficit involving the first sacral
nerve root in one patient, a pseudarthrosis in three patients, and a wound
infection in three patients. Six patients had extension of the arthrodesis
to include additional vertebrae.
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