ABSTRACT

To evaluate the results of surgical treatment of patients with an unincarcerated fully-segmented hemivertebra treated with hemivertebrectomy by a posterior approach alone, circumferential fusion and posterior segmental pedicular screw instrumentation.

Twelve patients with a mean age of 9.4 ± 5.4 (2–14) years were included in the study (6 girls and 6 boys). The mean duration of follow-up was 59.4 ± 39.6 (24–132) months. Diagnosis of a Type-IA hemivertebra was established by clinical, radiological, CT and MRI evaluation. For all patients, hemivertebrectomy with a posterior approach alone, circumferential fusion and posterior segmental pedicular screw instrumentation were applied. Analysis of the frontal and sagittal planes using radiograms obtained preoperatively, postoperatively, and after a minimum period of two years was performed. The balance was analyzed clinically and radiologically by measurement of the lateral trunk shift (LT).

The mean preoperative Cobb angle was 5.5 ± 23.4°, and postoperatively a mean correction rate of 89.4 ± 14.4% was obtained for the main curves (p=0.00). The mean preoperative Cobb angle of the secondary curves was 38.9 ± 16.1°, and postoperatively a mean correction rate of 88.9 ± 11.1% was obtained for the secondary curves (p=0.00). In the final follow-up, the mean loss of correction was 3.2 ± 3.3°. The local segmented kyphosis decreased from 24.4 ± 14.9° to 7.7 ± 5.7°. The trunk shift (LT) of the patients was corrected for all patients (preoperative mean LT: 3.3 ± 2.1 cm; postoperative mean LT: 0.7 ± 0.4 cm). Circumferential fusion was achieved in all cases. No neurological complications developed, the only complication seen was delayed wound healing.

In the light of these data, we conclude that hemivertebrectomy by a posterior approach alone, circumferential fusion and posterior segmental pedicular screw instrumentation is an effective and safe technique for the treatment of unincarcerated fully-segmented hemivertebrae in all vertebral regions.