Clinical outcomes of 1-stage posterior hemivertebra resection and monosegment fusion for growing children at the end of spinal growth: a mean 10-year follow-up study.

Objective: Congenital early-onset scoliosis (CEOS) resulting from hemivertebra requires early intervention if severe deformity is indicated. For a single hemivertebra, posterior hemivertebra resection and monosegment fusion can correct the deformity with minimal involvement of the spinal segment. Previous studies have shown that this technique is safe and effective, although most of the enrolled patients had not yet reached skeletal maturity. Because CEOS is a developmental condition, the ultimate clinical outcomes can only be determined once spinal growth is complete. Therefore, the authors conducted a long-term follow-up study in which all patients reached skeletal maturity to evaluate the outcomes of hemivertebra resection and monosegment fusion.

Methods: A retrospective study of CEOS patients treated with posterior hemivertebra resection and monosegment fusion was conducted between 2007 and 2017. At the latest follow-up, all patients had reached skeletal maturity (Risser sign ≥ 4 and age ≥ 14 years), with a mean ± SD follow-up duration of 10.5 ± 2.5 years. Demographic characteristics, coronal and sagittal deformity correction parameters, spinal and vertebral growth parameters, 22-item Scoliosis Research Society (SRS)-22 scores, and complications were analyzed.

Results: A total of 23 patients (15 males and 8 females) were enrolled, and the mean age was 4.8 ± 2.0 years. The preoperative main curve was 32.3° ± 14.4°, which significantly decreased to 7.3° ± 6.5° postoperatively, with a 15.4% loss of correction during follow-up. Sagittal kyphosis significantly improved and was maintained at the latest follow-up. Three patients had coronal imbalance preoperatively, which decreased to 1 patient at the latest follow-up. The T1-12 and T1-S1 heights increased from 15.9 ± 1.6 cm and 27.1 ± 1.7 cm preoperatively to 24.0 ± 2.2 cm and 37.3 ± 3.1 cm at the latest follow-up, respectively. The increase in vertebral body height and interpedicular length was comparable between instrumented vertebrae and noninstrumented vertebrae. The SRS-22 total score was 4.3 ± 0.2 at the latest follow-up. A total of 10 complications occurred in 7 patients.

Conclusions: Over long-term follow-up to skeletal maturity, the use of hemivertebra resection and monosegment fusion was a safe and effective surgical approach for single hemivertebra. Deformity correction was well maintained without detrimental effects on spinal growth and achieved acceptable patient-reported clinical outcomes.