TREATMENT OF CONGENITAL KYPHOSCOLIOSIS WITH SELECTIVE-PARTIAL HEMIVERTEBRA RESECTION AND INSTRUMENTATION VIA POSTERIOR APPROACH_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 ZHANGHongqi ¹ , CHUGe ¹ , PANChao ¹ , HUANGJia ¹ , HUWei ² , Aikemu·Kahaer ³

1. Department of Spine Surgery, Xiangya Hospital of Central South University, Changsha Hunan, 410008, P. R. China;
2. No.2 Department of Spine Surgery, Traditional Chinese Medicine Hospital Affiliated to Xinjiang Medical University;
3. No.1 Department of Spine Surgery, Traditional Chinese Medicine Hospital Affiliated to Xinjiang Medical University;

Corresponding?author：

ZHANGHongqi, Email: xiaochu138@sina.com

Keywords：

Congenital kyphoscoliosis; Hemivertebra; Posterior approach; Internal fixation

DOI：

10.7507/1002-1892.20150067

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Objective To investigate the effectiveness of selective-partial hemivertebra resection and instrumentation via posterior approach only for congenital kyphoscoliosis. Methods Between January 2008 and August 2011, 17 patients with congenital kyphoscoliosis were treated by selective-partial hemivertebra resection and instrumentation via posterior approach. There were 10 boys and 7 girls with the mean age of 10.8 years (range, 9-14 years). Of them, 15 cases had lumbar back pain, and 3 cases had lower limb numbness of nervous system damage symptoms. Risser sign was rated as grade 0 in 3 cases, grade 1 in 2 cases, grade 2 in 7 cases, and grade 3 in 5 cases. The classification of deformity was fully segmental hemivertebra. The deformity located at the thoracic segment in 9 cases, at the thoracolumbar segment in 4 cases, and at the lumbar segment in 4 cases. The Cobb angles of the main curves, segmental curves, and segmental kyphotic curves were measured at pre-operation, at 10 days after operation, and last follow-up to evaluate the correction effect. Results The 2-7 segments (mean, 3.7 segments) were fixed. The operation time was 4-6 hours (mean, 4.77 hours). The intraoperative bleeding was 300-1 100 mL (mean, 611.76 mL). All incisions healed by first intention, with no infection or complication of nervous system. All patients were followed up 6-37 months (mean, 20.12 months). Back pain and numbness of lower limbs were eliminated. X-ray films showed complete bone graft fusion at 6-18 months (mean, 12 months). At 10 days after operation and last follow-up, the Cobb angles of the main curves, segmental curves, and segmental kyphotic curves were significantly decreased compared with the preoperative angles (P<0.05); the Cobb angles of the main curves and segmental curves at last follow-up were significantly greater than those at 10 days after operation (P<0.05) except the segmental kyphotic curves angle (P>0.05). Postoperative correction rates of the Cobb angles of the segmental curve, the main curves, and segmental kyphotic curves were 64.35%±0.07%, 65.08%±0.07%, and 72.26%±0.11%, respectively; loss of correction was (3.04±1.17), (2.81±0.93), and (0.75±0.50)°, respectively. Conclusion For patients at the age of 9-14 years, with the Risser sign between grade 0-3, and with the Cobb angles less than 60°, the selective-partial hemivertebra resection and instrumentation via posterior approach can balance the growth on the two sides of the spine, and achieve satisfactory therapeutic effect through individualized treatment of extra growth center resection.

Citation： ZHANGHongqi, CHUGe, PANChao, HUANGJia, HUWei, Aikemu·Kahaer. TREATMENT OF CONGENITAL KYPHOSCOLIOSIS WITH SELECTIVE-PARTIAL HEMIVERTEBRA RESECTION AND INSTRUMENTATION VIA POSTERIOR APPROACH. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(3): 315-320. doi: 10.7507/1002-1892.20150067 Copy

1.	Giampietro PF, Blank RD, Raggio CL, et al. Congenital and idiopathic scoliosis:clinical and genetic aspects. Clin Med Res, 2003, 1(2):125-136.
2.	仉建國, 邱貴興, 劉勇, 等. 前后路一期半椎體切除術矯治脊柱側后凸. 中華骨科雜志, 2004, 24(5):257-261.
3.	Winter RB, Moe JH, Lonstein JE. Posterior spinal arthrodesis for congenital scoliosis. An analysis of the cases of two hundred and ninety patients, five to nineteen years old. J Bone Joint Surg (Am),1984, 66(8):1188-1197.
4.	Lazar RD, Hall JE. Simultaneous anterior and posterior hemivertebra excision. Clin Orthop Relat Res, 1999, (364):76-84.
5.	McMaster MJ, David CV. Hemivertebra as a cause of scoliosis. A study of 104 patients. J Bone Joint Surg (Br),1986, 68(4):588-595.
6.	Kesling KL, Lonstein JE, Denis F, et al. The crankshaft phenomenon after posterior spinal arthrodesis for congenital scoliosis:a review of 54 patients. Spine (Phila Pa 1976), 2003, 28(3):267-271.
7.	Uzumcugil A, Cil A, Yazici M, et al. Convex growth arrest in the treatment of congenital spinal deformities, revisited. J Pediatr Orthop, 2004, 24(6):658-666.
8.	張宏其, 劉少華, 郭超峰, 等. 后路半椎體切除短節段內固定融合治療青少年完全分節型半椎體脊柱畸形. 中國脊柱脊髓雜志, 2008, 18(7):517-521.
9.	Jalanko T, Rintala R, Puisto V, et al. Hemivertebra resection for congenital scoliosis in young children:comparison of clinical, radiographic, and health-related quality of life outcomes between the anteroposterior and posterolateral approaches. Spine (Phila Pa 1976), 2011, 36(1):41-49.
10.	Dimeglio A. Growth in pediatric orthopaedics. J Pediatr Orthop, 2001, 21(4):549-555.
11.	Ruf M, Harms J. Posterior hemivertebra resection with transpedicular instrumentation:early correction in children aged 1 to 6 years. Spine (Phila Pa 1976), 2003, 28(18):2132-2138.
12.	劉祖德, 李新鋒, 胡光宇, 等. 后路單側經椎弓根半椎體截骨治療青少年先天性脊柱側凸. 中國骨與關節外科, 2011, 4(4):270-274.
13.	Xu W, Yang S, Wu X, et al. Hemivertebra excision with short-segment spinal fusion through combined anterior and posterior approaches for congenital spinal deformities in children. J Pediatr Orthop B, 2010, 19(6):545-550.
14.	Bollini G, Docquier PL, Viehweger E, et al. Thoracolumbar hemivertebrae resection by double approach in a single procedure:long-term follow-up. Spine (Phila Pa 1976), 2006, 31(15):1745-1757.
15.	Smith JT, Gollogly S, Dunn HK. Simultaneous anterior-posterior approach through a costotransversectomy for the treatment of congenital kyphosis and acquired kyphoscoliotic deformities. J Bone Joint Surg (Am), 2005, 87(10):2281-2289.
16.	Mladenov K, Kunkel P, Stuecker R. Hemivertebra resection in children, results after single posterior approach and after combined anterior and posterior approach:a comparative study. Eur Spine J, 2012, 21(3):506-513.
17.	唐明星, 張宏其, 王永福, 等. 有限元法預測支具治療青少年特發性脊柱側凸的效果. 脊柱外科雜志, 2010, 8(2):108-113.
18.	Aydogan M, Ozturk C, Tezer M, et al. Posterior vertebrectomy in kyphosis, scoliosis and kyphoscoliosis due to hemivertebra. J Pediatr Orthop B, 2008, 17(1):33-37.
19.	Ruf M, Jensen R, Letko L, et al. Hemivertebra resection and osteotomies in congenital spine deformity. Spine (Phila Pa 1976), 2009, 34(17):1791-1799.
20.	Hosseinpour-Feizi H, Soleimanpour J, Sales JG, et al. Lenke and King classification systems for adolescent idiopathic scoliosis:interobserver agreement and postoperative results. Int J Gen Med, 2011, 4:821-825.
21.	李明, 麻文謙, 倪春鴻. 關于脊柱側凸Lenke分型. 中國脊柱脊髓雜志, 2006, 16(3):238-240.
22.	蔣淳, 姜曉幸, 馮振洲. 單一后路半椎體切除結合椎間融合器治療先天性脊柱畸形. 中國骨與關節外科, 2011, 4(4):275-282.

1. Giampietro PF, Blank RD, Raggio CL, et al. Congenital and idiopathic scoliosis:clinical and genetic aspects. Clin Med Res, 2003, 1(2):125-136.
2. 仉建國, 邱貴興, 劉勇, 等. 前后路一期半椎體切除術矯治脊柱側后凸. 中華骨科雜志, 2004, 24(5):257-261.
3. Winter RB, Moe JH, Lonstein JE. Posterior spinal arthrodesis for congenital scoliosis. An analysis of the cases of two hundred and ninety patients, five to nineteen years old. J Bone Joint Surg (Am),1984, 66(8):1188-1197.
4. Lazar RD, Hall JE. Simultaneous anterior and posterior hemivertebra excision. Clin Orthop Relat Res, 1999, (364):76-84.
5. McMaster MJ, David CV. Hemivertebra as a cause of scoliosis. A study of 104 patients. J Bone Joint Surg (Br),1986, 68(4):588-595.
6. Kesling KL, Lonstein JE, Denis F, et al. The crankshaft phenomenon after posterior spinal arthrodesis for congenital scoliosis:a review of 54 patients. Spine (Phila Pa 1976), 2003, 28(3):267-271.
7. Uzumcugil A, Cil A, Yazici M, et al. Convex growth arrest in the treatment of congenital spinal deformities, revisited. J Pediatr Orthop, 2004, 24(6):658-666.
8. 張宏其, 劉少華, 郭超峰, 等. 后路半椎體切除短節段內固定融合治療青少年完全分節型半椎體脊柱畸形. 中國脊柱脊髓雜志, 2008, 18(7):517-521.
9. Jalanko T, Rintala R, Puisto V, et al. Hemivertebra resection for congenital scoliosis in young children:comparison of clinical, radiographic, and health-related quality of life outcomes between the anteroposterior and posterolateral approaches. Spine (Phila Pa 1976), 2011, 36(1):41-49.
10. Dimeglio A. Growth in pediatric orthopaedics. J Pediatr Orthop, 2001, 21(4):549-555.
11. Ruf M, Harms J. Posterior hemivertebra resection with transpedicular instrumentation:early correction in children aged 1 to 6 years. Spine (Phila Pa 1976), 2003, 28(18):2132-2138.
12. 劉祖德, 李新鋒, 胡光宇, 等. 后路單側經椎弓根半椎體截骨治療青少年先天性脊柱側凸. 中國骨與關節外科, 2011, 4(4):270-274.
13. Xu W, Yang S, Wu X, et al. Hemivertebra excision with short-segment spinal fusion through combined anterior and posterior approaches for congenital spinal deformities in children. J Pediatr Orthop B, 2010, 19(6):545-550.
14. Bollini G, Docquier PL, Viehweger E, et al. Thoracolumbar hemivertebrae resection by double approach in a single procedure:long-term follow-up. Spine (Phila Pa 1976), 2006, 31(15):1745-1757.
15. Smith JT, Gollogly S, Dunn HK. Simultaneous anterior-posterior approach through a costotransversectomy for the treatment of congenital kyphosis and acquired kyphoscoliotic deformities. J Bone Joint Surg (Am), 2005, 87(10):2281-2289.
16. Mladenov K, Kunkel P, Stuecker R. Hemivertebra resection in children, results after single posterior approach and after combined anterior and posterior approach:a comparative study. Eur Spine J, 2012, 21(3):506-513.
17. 唐明星, 張宏其, 王永福, 等. 有限元法預測支具治療青少年特發性脊柱側凸的效果. 脊柱外科雜志, 2010, 8(2):108-113.
18. Aydogan M, Ozturk C, Tezer M, et al. Posterior vertebrectomy in kyphosis, scoliosis and kyphoscoliosis due to hemivertebra. J Pediatr Orthop B, 2008, 17(1):33-37.
19. Ruf M, Jensen R, Letko L, et al. Hemivertebra resection and osteotomies in congenital spine deformity. Spine (Phila Pa 1976), 2009, 34(17):1791-1799.
20. Hosseinpour-Feizi H, Soleimanpour J, Sales JG, et al. Lenke and King classification systems for adolescent idiopathic scoliosis:interobserver agreement and postoperative results. Int J Gen Med, 2011, 4:821-825.
21. 李明, 麻文謙, 倪春鴻. 關于脊柱側凸Lenke分型. 中國脊柱脊髓雜志, 2006, 16(3):238-240.
22. 蔣淳, 姜曉幸, 馮振洲. 單一后路半椎體切除結合椎間融合器治療先天性脊柱畸形. 中國骨與關節外科, 2011, 4(4):275-282.

Chinese Journal of Reparative and Reconstructive Surgery

TREATMENT OF CONGENITAL KYPHOSCOLIOSIS WITH SELECTIVE-PARTIAL HEMIVERTEBRA RESECTION AND INSTRUMENTATION VIA POSTERIOR APPROACH

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