ABSTRACT

Purpose:

The aim of this study is to evaluate the minimal five years results of fully segmented unlocked hemivertebral congenital scoliosis patients who undergone hemivertebrectomy

Patients and method:

20 fully segmented unlocked hemivertebrae patients whose average age was 12.3 ± 1.6 and had mean follow-up time 102.6 ± 20.5 months evaluated retrospectively. We performed posterior and then anterior hemivertebrectomy, circumferential fusion after correction with decompression of the defect caused by anterior instrumentation in 9 patients. Posterior after anterior hemivertebrectomy and posterior fusion were performed in remaining 11 patients. Frontal plan curves and saggittal contours were compared with calculating the preoperative, postoperative and final values. The "Lateral Trunk Shift"- LT and "Shift of Head" - SH values were identified for body equilibrium analyses and signed as vertebral unit (VU). SRS-22 questionarie was used for clinical evaluation at last follow-ups.

Results:

When preoperative mean Cobb angle was 46.2°±12.4°, it decreased to 17.2° ± 7.9° with average 63.8 ± 12.3 % correction rate (p < 0.05). Average final correction rate was 60.5 ± 11 % with mean 2.8° ± 1.8° correction loss. There was not statistically significant difference in postoperative and last Cobb angles in posterior and anterior instrumentation groups (p > 0.05). Minimal correction loss were found and there was not spontaneous correction in both groups. When equilibrium values evaluated the LT and SH values were found 1.36 ± 0.50 VU and 1.11 ± 0.34 VU preoperatively and statistically significant correction was found postoperatively as 66.6 ± 16.8 % and 66.8 ± 22.1 %, respectively (p < 0.05). When non of the patients were "fully balanced" (SH: 0 VU) or "balanced" (0 VU < SH < 0.5 VU) preoperatively, the body balance was provided in 18 patients (90.0 %) postoperatively. It was detected that this rate was preserved at last visits and there was minimal correction loss in balance values. Circumferential fusion was detected in all patients. SRS-22 scores were determined 4.5 ± 0.4, 4.5 ± 0.5, 4.6 ± 0.4, 4.3 ± 0.4 and 4.5 ± 0.5 in pain, function, mental status, appearance and satisfaction from treatment, respectively at last follow up visits. There was not any neurological problem and local and systemic early or late complication except one patient who had wound healing problem that treated medically.

Conclusion:

It was concluded that anterior or posterior instrumentation after total hemivertebrectomy had high correction and fusion rates in preadolescent and adolescent patients, body balance can be obtained with both two methods in most of the patients and satisfactory clinical results can be achieved at 5 years follow-up.