Abstract：Objective To investigate the value of intraoperative O-arm navigation in posterior hemivertebra resection for treatment of congenital kyphoscoliosis caused by fully segmented hemivertebr.Methods From January 2014 to March 2015, a total of 14 patients with congenital kyphoscoliosis caused by fully-segmented hemivertebra who had undergone hemivertebra resection surgery at the Third Hospital of Hebei Medical University were reviewed retrospectively. There were 5 males and 9 females with an average of 11.9 years (ranged from 9 to 15 years). Among them, the hemivertebra were located at T9, L2 in each 1 patients, T10, L1 in each 2 patients, T12 in 3 patients, T11 in 5 patients. Full-length standing radiographs were taken before surgery. The Cobb angle in the coronal and sagittal plane were measured and analyzed. All pedicle screws insertion was performed guided by intraoperative O-arm navigation. According to the comparison of intraoperative O-arm navigation in three-dimensional reconstruction of the hemivertebra, the scope of hemivertebra resection could be determined, and then individualized, thoroughly and effectively resected the hemivertebra. The screw position was observed by O-arm scan in operation and CT scan after surgery. And the pre- and post-operative changes of the Cobbs angle were analyzed in order to evaluate the correction rate of scoliosis and kyphosis.Results All the 120 screws for 14 patients were inserted exactly. The surgery time was (195.4±17.4) min and blood loss was (611.9±173.0) mL. All the patients were followed up from 3 to 15 months(average 9.6 months). Scoliosis angle was corrected from 62.8°±15.8° to 10.9°± 5.3° with a correction rate of 83.34%±6.08%. At the last follow-up, the scoliosis angle was 12.1°±4.8° with no significant loss of correction. Kyphosis angle was corrected from 57.5°±15.5° to 17.0°±6.6° with a correction rate of 70.66%± 6.79%. At the last follow-up, the kyphosis angle was 17.9°±7.0° with no significant loss of correction. They were compared pre- and post-operative respectively, with significant differences(all P values＜0.01). However, there were no significant differences between postoperative and the final follow-up(all P values＞0.05). No implants failure and correction lost were found during the follow-up.Conclusions In posterior approach hemivertebra resection for congenital kypho scoliosis patients caused by fully segmented hemivertebr, the use of intraoperative O-arm navigation can make screws insertion more accurate and safe. And resection of the hemivertebr is more accurate. In this way, it can reduce the complications and improve the safety of operation.
王峰,杜伟,杨刚,王林峰,申勇,丁文元,孟宪中,张英泽. O-arm导航辅助下后路半椎体切除治疗先天性脊柱侧后凸畸形[J]. 中华解剖与临床杂志, 2016, 21(4): 331-336.
Wang Feng, Du Wei, Yang Gang, Wang Linfeng, Shen Yong, Ding Wenyuan, Meng Xianzhong, Zhang Yingze. Application of intraoperative O-arm navigation in posterior hemivertebra resection for treatment of congenital kyphoscoliosis. Chinese Journal of Anatomy and Clinics, 2016, 21(4): 331-336.
Steinmann JC, Herkowitz HN, el-Kommos H, et al. Spinal pedicle fixation. Confirmation of an image-based technique for screw placement[J]. Spine (Phila Pa 1976), 1993, 18(13): 1856-1861
[3]
Raley DA, Mobbs RJ. Retrospective computed tomography scan analysis of percutaneously inserted pedicle screws for posterior transpedicular stabilization of the thoracic and lumbar spine accuracy and complication rates[J]. Spine (Phila Pa 1976), 2012, 37(12): 1092-1100. DOI:10.1097/BRS.0b013e31823c80d8
[4]
Jalanko T, Rintala R, Puisto V, et al. Hemivertebra resection for congenital scoliosis in young children: comparison of clinical, radiographic, and health-related quality of life outcomes between the anteroposterior and posterolateral approaches[J]. Spine (Phila Pa 1976), 2011, 36(1): 41-49. DOI:10.1097/BRS.0b013e3181ccafd4
[5]
Mcmaster MJ, Ohtsuka K. The natural history of congenital scoliosis. A study of two hundred and fifty-one patients[J]. J Bone Joint Surg Am, 1982, 64(8): 1128-1147
[6]
Marks DS, Qaimkhani SA. The natural history of congenital scoliosis and kyphosis[J]. Spine (Phila Pa 1976), 2009, 34(17): 1751-1755. DOI:10.1097/BRS.0b013e3181af1caf
[7]
Leatherman KD, Dickson RA. Two-stage corrective surgery for congenital deformities of the spine[J]. J Bone Joint Surg Br, 1979, 61-B(3): 324-328
Crostelli M, Mazza O, Mariani M. Posterior approach lumbar and thoracolumbar hemivertebra resection in congenital scoliosis in children under 10 years of age: results with 3 years mean follow up[J]. Eur Spine J, 2014, 23(1): 209-215. DOI:10.1007/s00586-013-2933-z
[10]
Mladenov K, Kunkel P, Stuecker R. Hemivertebra resection in children, results after single posterior approach and after combined anterior and posterior approach: a comparative study[J]. Eur Spine J, 2012, 21(3): 506-513. DOI:10.1007/s00586-011-2010-4
[11]
Shono Y, Abumi K, Kaneda K. One-stage posterior hemivertebra resection and correction using segmental posterior instrumentation[J]. Spine (Phila Pa 1976), 2001, 26(7): 752-757
Wang S, Zhang J, Qiu G, et al. Posterior hemivertebra resection with bisegmental fusion for congenital scoliosis: more than 3 year outcomes and analysis of unanticipated surgeries[J]. Eur Spine J, 2013, 22(2): 387-393. DOI:10.1007/s00586-012-2577-4
[14]
Peng X, Chen L, Zou X. Hemivertebra resection and scoliosis correction by a unilateral posterior approach using single rod and pedicle screw instrumentation in children under 5 years of age[J]. J Pediatr Orthop B, 2011, 20(6): 397-403. DOI:10.1097/BPB.0b013e3283492060
[15]
Obeid I, Bourghli A, Vital JM. Lumbar hemivertebra resection by posterior approach for congenital scoliosis[J]. Eur Spine J, 2012, 21(12): 2721-2723. DOI:10.1007/s00586-012-2569-4
[16]
Haberland N, Ebmeier K, Grunewald JP, et al. Incorporation of intraoperative computerized tomography in a newly developed spinal navigation technique[J]. Comput Aided Surg, 2000, 5(1): 18-27
[17]
Samdani AF, Ranade A, Sciubba DM, et al. Accuracy of free-hand placement of thoracic pedicle screws in adolescent idiopathic scoliosis: how much of a difference does surgeon experience make?[J]. Eur Spine J, 2010, 19(1): 91-95. DOI:10.1007/s00586-009-1183-6
[18]
Ruf M, Jensen R, Jeszenszky D, et al. Hemivertebra resection in congenital scoliosis-early correction in young children[J]. Z Orthop Ihre Grenzgeb, 2006, 144(1): 74-79. DOI:10.1055/s-2006-921417
[19]
Kosmopoulos V, Schizas C. Pedicle screw placement accuracy: a meta-analysis[J]. Spine (Phila Pa 1976), 2007, 32(3): E111-E120. DOI:10.1097/01.brs.0000254048.79024.8b
[20]
Larson AN, Santos ER, Polly DW, et al. Pediatric pedicle screw placement using intraoperative computed tomography and 3-dimensional image-guided navigation[J]. Spine (Phila Pa 1976), 2012, 37(3): E188-E194. DOI:10.1097/BRS.0b013e31822a2e0a
[21]
Zausinger S, Scheder B, Uhl E, et al. Intraoperative computed tomography with integrated navigation system in spinal stabilizations[J]. Spine (Phila Pa 1976), 2009, 34(26): 2919-2926. DOI:10.1097/BRS.0b013e3181b77b19
2016, Vol. 21 
