Long-term efficacy of pediatric congenital hemivertebra deformity after posterior hemivertebrectomy with unilateral short-segment fixation
Wang Shixiong1,2, Xue Xuhong1, Zhao Sheng1, Gao Ze1,2, Zhang Yandong1,2, Xi Fanhui1,2, Guo Weijie1,2
1Department of Orthopaedics, the Second Hospital of Shanxi Medical University, Taiyuan 030001, China; 2the Second Clinical Medical School of Shanxi Medical University, Taiyuan 030001, China
Abstract：Objective This study aimed to investigate the long-term efficacy of posterior hemilaminectomy with unilateral short-segment fixation in pediatric congenital hemivertebra malformations. Methods This was a series case report. Clinical data of 26 children with congenital hemivertebra malformations admitted to the Department of Orthopedics of the Second Hospital of Shanxi Medical University from January 2000 to January 2018, were included. The patients consisted of 12 males and 14 females, aged 2-12 (5.4±2.9) years. The hemivertebra malformations were all single, including 17 cases of complete segmental type and nine cases of hemi-segmental type. The children were treated with posterior hemilaminectomy with unilateral short-segment fixation. Observation indicators: (1) The duration of the operation; the amount of intraoperative bleeding; and the occurrence of postoperative complications, such as infection and nerve damage, were analyzed. (2) The scoliosis Cobb angle, sagittal axial distance (SVA), thoracic kyphosis (TK) angle, and local kyphosis angle before surgery; immediately after surgery; and 6 months, 1 year, and 5 years after surgery were compared to evaluate the orthopedic effect. The correction rates of the immediate postoperative lateral convex Cobb angle and localized posterior convex angle were compared. (3) The convex and concave heights of proximal vertebral bodies (PVB)and distal vertebral bodies (DVB) and the bilateral pedicle distance (BLPD) were compared before and 1-5 years after surgery. The total growth rate of each index in 5 years after the operation was analyzed. Results (1) All 26 surgeries were successfully completed with no perioperative deaths. The duration of surgery ranged from 84 min to 174 (120.0±24.0) min. The intraoperative bleeding was 75-130 (100.0±16.1) mL. The immediate postoperative scoliosis Cobb angle correction rate was 66.3%±18.4%. The localized posterior convexity correction rate was 47.7%±40.4%. The postoperative incision healed well without complications such as infection and nerve damage. (2) All 26 patients were followed up for 60-82 (68.8±8.1) months. The preoperative, immediate postoperative, 6-month postoperative, 1-year postoperative, and 5-year postoperative Cobb angles of lateral convexity were 36.3°±11.4°, 12.3°±7.4°, 12.1°±7.4°, 12.1°±7.5°, and 12.6°±7.4°, respectively, and SVAs were 2.1°±1.1°, 2.2°±0.9°, 2.3°±1.0°, 2.4°±0.9°, and 2.3°±1.2°, respectively; the TK angles were 26.1°±9.2°, 23.4°±8.1°, 23.6°±8.1°, 23.9°±8.0°, and 28.5°±8.9°, respectively; and the localized posterior convexity angles were 21.8°±10.1°, 9.8°±6.0°, 9.7°±5.8°, 9.8°±6.2°, and 9.7°±5.3°, respectively. The immediate postoperative and 6-month and 1-year postoperative lateral convex Cobb angle, TK angle, and localized posterior convexity angle of the patients were smaller than those at pre-operation, and the lateral convexity Cobb angle and localized posterior convexity angle were less than those at pre-operation and 5 years post-operation. The differences were statistically significant (all P values <0.05). The differences of the SVA at different postoperative time points and TK angle at 5 years post-operation compared with those at pre-operation were statistically significant (all P values >0.05). (3) The convex lateral height, concave lateral height, and BLPD of the PVB and DVB in 26 patients showed an increasing trend from 1 year to 5 years after surgery compared with the preoperative period. The differences were statistically significant (FPVB = 76.12, 34.80, 13.27 and FDVB = 108.13, 59.94, 20.40, all P values <0.001). The convex lateral height total growth rates of the PVB and DVB at 5 years after surgery were 106.4%±89.3% and 96.9%±74.1%, respectively; the total growth rates of concave lateral height were 91.0%±93.5% and 96.2%±101.3%, respectively; the BLPD total growth rates were 37.0%±47.7% and 40.4%±70.3%, respectively. Conclusion The posterior hemivertebra resection with unilateral short-segment fixation and fusion for the treatment of congenital hemivertebra deformity in pediatric patients can achieve satisfactory orthopedic results. The correction is well maintained at 5-year follow-up, making it a safe and effective treatment for this type of deformity.
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2024, Vol. 29 
