[Surgical therapy of hemivertebrae scoliosis and kyphosis--a retrospective analysis of 53 cases].
OBJECTIVE
We performed a retrospective analysis of the results of operative treatment of 53 patients with congenital scoliosis (n = 47) or kyphosis (n = 6) due to hemivertebrae.


METHODS
The mean age of the patients (31 girls and 22 boys) at the time of the initial examination was 6 +/- 4 years. Surgical treatment was carried out on average at the age of 9 +/- 5 years. Follow-up examinations were carried out up to a mean age of 16 +/- 6 years.


RESULTS
The results of operative treatment depended on the localization of the hemivertebrae and the surgical technique. Progression of scoliosis due to a thoracic hemivertebra was halted, but the scoliosis could not be corrected (Cobb angle at initial examination 37 +/- 17 degrees at follow-up 34 +/- 23 degrees). Scoliosis due to lumbar hemivertebrae was reduced by surgery (Cobb angle at initial examination 36 +/- 14 degrees, at follow-up 21 +/- 15 degrees). Surgery without instrumentation led to worse results than did surgery with instrumentation with thoracic as well as lumbar scoliosis. Combined dorsoventral procedures with resection of the hemivertebra seemed to be superior to spondylodesis without resection of the hemivertebra. Surgical correction of kyphosis associated with dorsal hemivertebrae was performed by means of dorsal or dorsoventral spondylodesis with hemivertebra resection (preoperative kyphosis 70 +/- 34 degrees, at follow-up 44 +/- 25 degrees).


CONCLUSIONS
Spondylodesis without instrumentation is associated with an unsure prognosis with respect to effects on the progression of the scoliosis, even if it is performed on very young patients. In contrast, spondylodesis with instrumentation can achieve better and longer-lasting corrections of scoliosis even with larger initial curvatures. Scoliosis due to lumbar hemivertebrae is more amenable to surgical correction than thoracic scoliosis due to hemivertebrae.
Muschik
M
M
Orthopädische Klinik der Charité, Humboldt-Universität zu Berlin.
Tirschmann
G
G
Robinson
P N
PN
Zippel
H
H
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007738:Kyphosis / Q000151:congenital / Q000000981:diagnostic imaging / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D011859:Radiography; D012600:Scoliosis / Q000151:congenital / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion; D013904:Thoracic Vertebrae / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery