“Skipping” posterior hemivertebra resection with short segmental fusion for congenital kyphoscoliosis due to nonadjacent fully segmented hemivertebrae in children

Abstract Objective: To describe the technique and evaluate the results of “skipping” posterior hemivertebra resection with short segmental fusion for the treatment of progressive complex congenital spinal deformities due to nonadjacent hemivertebrae. Methods: This study was a retrospective case series. Twelve patients, consisting of six males and six females, with congenital kyphoscoliosis caused by nonadjacent fully segmented hemivertebrae and with an average age of 4.6 years (ranging from 3 to 9 years), were enrolled. Whole standing spine radiographs were used to measure various parameters including the Cobb angle of the segmental curve and the compensatory curve, segmental kyphosis, thoracic kyphosis, lumbar lordosis, trunk shift, sagittal vertical alignment, and T1-S1 length before surgery, after surgery, and at the latest follow-up evaluation. Additionally, the hemivertebral location, fused segment, operation time, and blood loss were assessed. Results: All patients were followed up for a minimum of 2 years. On average, each patient had 2.6 fused segments and each hemivertebra had 1.3 fused segments. The segmental scoliosis measurement was 43.0° before surgery, 4.7° after surgery, and 7.8° at the latest follow-up evaluation. Segmental kyphosis measurements improved from 15.4° to 6.5°. The compensatory cranial and caudal curves were corrected by 86.7% and 83.5%, respectively. Trunk shift improved from 22.3 mm to 7.9 mm. The length of T1-S1 was 25.3 cm before surgery, 27.5 cm after surgery, and 34.7 cm at the latest follow-up evaluation. Two patients required revision surgery due to decompensation during the follow-up period. Conclusions: “Skipping” posterior hemivertebra resection with short segmental fusion could provide satisfactory correction with limited fusion. However, decompensation may occur during follow-up. The prognosis of the discs between two fusion masses needs to be evaluated in the future.