Posterior-only hemivertebra bone-disc-bone osteotomy (BDBO) without internal fixation in a 15-day-old neonate with 18-year follow-up.

Purpose: To report the long-term follow-up outcome of a 15-day-old neonate with congenital scoliosis treated with posterior-only hemivertebra bone-disc-bone osteotomy (BDBO) without internal fixation.

Methods: A 15-day-old neonate presented with a lumbar dorsal bulge exhibiting central ulceration and fluid discharge, necessitating emergency hospital admission. The comprehensive imaging study showed a fully segmented right L5 hemivertebra, L3-L4 fusion, and anterior bone bar of T10-T11, syringomyelia at the L2 level, type I diastematomyelia at the L3-L4 level, open spinal meningocele, and tethered cord. Prior to surgery, the patient received a 3-day course of antibiotics to address potential infection concerns. Subsequently, the patient underwent concurrent procedures including repair of the spinal meningocele, resection of the bone crest, release of tethering, and posterior-only hemivertebra type 1 BDBO without internal fixation.

Results: The surgical procedure lasted 165 min, accompanied by an intraoperative blood loss of approximately 50 mL and a blood transfusion of 50 mL. Preoperatively, the patient's hemoglobin level was 159 g/L, which decreased to 138 g/L postoperatively, with no complications. After the operation, the patient achieved a good correction of the spinal curve. The 18-year postoperative follow-up showed further improvement in the correction with good coronal and sagittal balance. The facet joint between the residual L5 hemivertebra and S1, as well as the contralateral facet joint was well preserved, with no pseudoarthrosis formation and a good spinal range of motion.

Conclusion: Posterior-only hemivertebra BDBO without internal fixation might be a simple, safe, effective and feasible surgical procedure for managing lumbosacral hemivertebra in very young children.