[TREATMENT OF CONGENITAL KYPHOSCOLIOSIS WITH SELECTIVE-PARTIAL HEMIVERTEBRA RESECTION AND INSTRUMENTATION VIA POSTERIOR APPROACH].
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2015 Mar;29(3):315-20
Authors: Zhang H, Chu Ge, Pan C, Huang J, Hu W, Aikemu-Kahaer
OBJECTIVE: To investigate the effectiveness of selective-partial hemivertebra resection and instrumentation via posterior approach only for congenital kyphoscoliosis.
METHODS: Between January 2008 and August 2011, 17 patients with congenital kyphoscoliosis were treated by selective-partial hemivertebra resection and instrumentation via posterior approach. There were 10 boys and 7 girls with the mean age of 10.8 years (range, 9-14 years). Of them, 15 cases had lumbar back pain, and 3 cases had lower limb numbness of nervous system damage symptoms. Risser sign was rated as grade 0 in 3 cases, grade 1 in 2 cases, grade 2 in 7 cases, and grade 3 in 5 cases. The classification of deformity was fully segmental hemivertebra. The deformity located at the thoracic segment in 9 cases, at the thoracolumbar segment in 4 cases, and at the lumbar segment in 4 cases. The Cobb angles of the main curves, segmental curves, and segmental kyphotic curves were measured at pre-operation, at 10 days after operation, and last follow-up to evaluate the correction effect.
RESULTS: The 2-7 segments (mean, 3.7 segments) were fixed. The operation time was 4-6 hours (mean, 4.77 hours). The intraoperative bleeding was 300-1 100 mL (mean, 611.76 mL). All incisions healed by first intention, with no infection or complication of nervous system. All patients were followed up 6-37 months (mean,20.12% months). Back pain and numbness of lower limbs were eliminated. X-ray films showed complete bone graft fusion at 6-18 months (mean, 12 months). At 10 days after operation and last follow-up, the Cobb angles of the main curves, segmental curves, and segmental kyphotic curves were significantly decreased compared with the preoperative angles (P < 0.05); the Cobb angles of the main curves and segmental curves at last follow-up were significantly greater than those at 10 days after operation (P < 0.05) except the segmental kyphotic curves angle (P > 0.05). Postoperative correction rates of the Cobb angles of the segmental curve, the main curves, and segmental kyphotic curves were 64.35% ± 0.07%, 65.08% ± 0.07%, and 72.26% ± 0.11%, respectively; loss of correction was (3.04 ± 1.17), (2.81 ± 0.93), and (0.75 ± 0.50) degrees, respectively.
CONCLUSION: For patients at the age of 9-14 years, wit the Risser sign between grade 0-3, and with the Cobb angles less than 60 degrees, the selective-partial hemivertebra resection and instrumentation via posterior approach can balance the growth on the two sides of the spine, and achieve satisfactory therapeutic effect through individualized treatment of extra growth center resection.
PMID: 26455197 [PubMed – in process]